Persistent polypharmacy and fall injury risk: the Health, Aging and Body Composition Study

Abstract

Background Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults. Methods The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in 4.6 ± 2.9 years) were defined as the initial claim with an ICD-9 fall E-code and non-fracture injury, or fracture code with/without a fall code from 1998/99 clinic visit to 12/31/08. Those without fall injury (N = 1219) were followed for 8.1 ± 2.6 years. Stepwise Cox models of fall injury risk with a time-varying variable for persistent polypharmacy (defined as ≥6 prescription medications at the two most recent consecutive clinic visits) were adjusted for demographics, lifestyle characteristics, chronic conditions, and functional ability. Sensitivity analyses explored if persistent polypharmacy both with and without fall risk increasing drugs (FRID) use were similarly associated with fall injury risk. Results Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk (hazard ratio [HR]: 1.31 [1.06, 1.63]) after adjusting for covariates. Persistent polypharmacy with FRID use was associated with a 48% increase in fall injury risk (95%CI: 1.10, 2.00) vs. those who had non-persistent polypharmacy without FRID use. Risks for persistent polypharmacy without FRID use (HR: 1.22 [0.93, 1.60]) and non-persistent polypharmacy with FRID use (HR: 1.08 [0.77, 1.51]) did not significantly increase compared to non-persistent polypharmacy without FRID use. Conclusions Persistent polypharmacy, particularly combined with FRID use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings. Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk.

Deprescribing Medications that Increase the Risk of Falls in Older People: Exploring Doctors' Perspectives Using the Theoretical Domains Framework (TDF)

“…A systematic review found that 65–93% of patients admitted with a fall-related injury were on FRIDs at the time of hospitalisation [ 11 ]. Polypharmacy that includes FRIDs was associated with increased risk for fall injuries that require medical care [ 12 ].…”

“…Deprescribing FRIDs could be a possible preventive measure in older people and an important component of falls prevention programmes, along with other health and environmental safety measures [ 23 ]. Such interventions might reduce the risk of falls injuries that require medical treatment [ 12 ].…”

Trauma-related falls in an urban geriatric population: predictive risk factors for poorer clinical outcomes

“…Injuries from these falls are associated with substantial morbidity and mortality in the geriatric population, causing both fatal and non-fatal injuries (Ziere et al 2006 ; Zia et al 2015 ). Almost 33% of individuals 65 years of age and older and 50% of individuals over 80 will experience a fall annually, suggesting that injuries related to these falls are becoming a public health concern that must not go overlooked (Xue et al 2021 ; Smith et al 2017 ).…”

“…Numerous studies (Davies et al 2020 ; Ziere et al 2006 ; Zia et al 2015 ; Xue et al 2021 ) have demonstrated the association between falls and polypharmacy in the elderly population. Although there is substantial evidence for improved clinical outcomes from disease-specific medications, the cumulative side effect profile may contribute to the increased incidence of falls and, potentially, lead to increased morbidity and mortality associated with trauma injuries in the geriatric population (Moreland et al 2020 ; Zia et al 2015 ).…”

Drug-induced fall risk in older patients: A pharmacovigilance study of FDA adverse event reporting system database

“…Falls studies have determined that taking ≥4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls ( Zia et al, 2015 ). The Health, Aging and Body Composition Study included 1764 community-dwelling adults demonstrated polypharmacy, particularly combined with fall risk increasing drugs use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings ( Xue et al, 2021 ). Therefore, the cautious use of fall risk increasing drugs is critical for reducing the occurrence of falls.…”