Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk

Abstract

The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug-drug or drug-disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.

Geriatric falls and risk factors

“…Although many geriatricians consider polypharmacy (defined as taking 4 or more chronic medications) to be unavoidable among older patients, PP was a significant risk factor of falls in our study, as it is supported by different surveys and reviews [6,13,18].…”

“…In other words it shows the probability of an outcome (fall) if the patient has the tested condition (takes the particular drug). These proportions only have limited validity in clinical practice, 13 however. The predictive values of a clinical test depend critically on the prevalence of the condition (falls) in the patients being tested within a particular environment [55].…”

“…Polypharmacy (PP) also increases the prevalence of drug-related problems, such as drug-drug interactions, adverse drug reactions, prescription errors and non-adherence [10,11]. Though there is no consensus about the exact cut-off value for polypharmacy, usually it is defined as the concomitant use of more than or equal to 4-8 chronic medications [6,12,13]. Polypharmacy is quite common in geriatric patients: the prevalence in the U.S. is around 57%, while a large European study reported 39.4% above the age of 65 [14,15].…”

The development of a novel method of recording centre of gravity location in bipedal stance in healthy adults

“…In older adults associations have been identified between activity levels and hip fracture (Hoidrup et al, 2001;Nitz et al, 2013). There are interactions also between polypharmacy (≥4 medications) and falls (Richardson et al, 2015;Zia, Kamaruzzaman, & Tan, 2015) in older adults. The use of multiple medications (that is ≥4 drugs) with or without the use of drugs which are known to increase risk of falls (for example, antipsychotics, anti-parkinsonian drugs and narcotic analgesics) is a significant factor in increasing the risk of falls (Zia et al, 2015).…”

“…There are interactions also between polypharmacy (≥4 medications) and falls (Richardson et al, 2015;Zia, Kamaruzzaman, & Tan, 2015) in older adults. The use of multiple medications (that is ≥4 drugs) with or without the use of drugs which are known to increase risk of falls (for example, antipsychotics, anti-parkinsonian drugs and narcotic analgesics) is a significant factor in increasing the risk of falls (Zia et al, 2015). As these factors impact on balance, it is possible that different results might have been found if the study participants had been a less active group.…”