Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study

Izza, Madeline A. D.; Lunt, Eleanor; Gordon, Adam L; Gladman, John; Armstrong, Sarah; Logan, Pip

doi:10.1007/s41999-020-00376-1

Cited by 28 publications

(24 citation statements)

References 23 publications

(28 reference statements)

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“…In the present study, we defined the time of enrollment as the start of follow up; therefore 30‐day follow up was very short term, and patients might still be very careful to adhere to the discharge education program, such as falls prevention and a healthy lifestyle. However, regarding the long‐term follow up, we found that older inpatients with polypharmacy had a higher risk of 90‐day falls (OR 1.73, 95%CI 1.04, 2.80) and 1‐year falls (OR 1.44, 95% CI 1.03–2.02), which was in line with other previous studies 11,15 . In a 2020 study of nursing home residents, polypharmacy was a stronger risk factor of falls; with the greater number of medications, the higher risk of falling 15 .…”

Section: Discussionsupporting

confidence: 89%

“…However, regarding the long‐term follow up, we found that older inpatients with polypharmacy had a higher risk of 90‐day falls (OR 1.73, 95%CI 1.04, 2.80) and 1‐year falls (OR 1.44, 95% CI 1.03–2.02), which was in line with other previous studies 11,15 . In a 2020 study of nursing home residents, polypharmacy was a stronger risk factor of falls; with the greater number of medications, the higher risk of falling 15 . This association was also supported by a study of Dhalwani et al .…”

Section: Discussionsupporting

confidence: 89%

“…We did not display the exact name of the medication; therefore, we cannot analyze what kinds of medication have stronger effects on adverse outcomes. A previous study suggested that those taking antidepressants or benzodiazepines had a higher risk of falls 15 . However, the present study had some strengths.…”

Section: Discussionmentioning

confidence: 84%

“…In addition, most of these studies mainly focused on community‐dwelling 11,14 or nursing home residents 12,15 . Some important confounding factors – malnutrition, depression and cognitive impairment – which are strongly related to falls, were not adjusted, leading to overestimating the independent association.…”

Section: Introductionmentioning

confidence: 99%

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Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study

Zhang

Jiao

Guo

et al. 2021

Geriatrics Gerontology Int

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Aim Polypharmacy is prevalent among older adults and has been mainly reported to be associated with falls among community‐dwelling or nursing home residents. Our study aimed to investigate the relationship between polypharmacy and falls among older Chinese hospitalized patients. Methods A nationwide prospective cohort study included 9062 participants in six hospitals from China aged ≥65 years, with a 1‐year follow‐up period. Baseline polypharmacy and other health‐related variables were collected when older inpatients were recruited on hospital admission. Polypharmacy was defined as patients who have taken five medications or more. Well‐trained nurses assessed falls by telephone at follow up. We used multivariate logistic regression analysis to examine the association between polypharmacy and the risk of falls based on cross‐sectional analyses and longitudinal analyses. Results Of 9062 participants, the mean age was 72.42 years (SD= 5.69), and 5228 (57.69%) were men. After fully adjusted for age, sex, education, depression, cognitive impairment, low handgrip strength, frailty, various hospitals, and nutritional status, the cross‐sectional and longitudinal analyses showed that inpatients with polypharmacy had an increased risk of falls (OR 1.37, 95%CI 1.17–1.56 for the cross‐sectional association; OR 1.43, 95% CI 1.01–2.03 for the longitudinal association, respectively), compared with those without polypharmacy. In addition, subgroup analyses of the association between polypharmacy and 1‐year falls, or history of falls was unchanged. Conclusions Polypharmacy was prevalent among older Chinese hospitalized patients and was an independent risk factor of 1‐year falls, suggesting that clinicians should make a comprehensive assessment of medications, and deprescribing strategies should be implemented to reduce unnecessary medications for decreasing the rate of falls. Geriatr Gerontol Int 2021; 21: 810–817.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study

Zhang

Jiao

Guo

et al. 2021

Geriatrics Gerontology Int

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“…In another study, the number of fall-risk medications was associated with fall-related hospital admissions though polypharmacy could not be identified as an independent risk factor [ 79 ]. Recently, a prospective cohort study also revealed that polypharmacy is associated with an increased falls risk in UK care home residents [ 80 ].…”

Section: Search Strategymentioning

confidence: 99%

Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

2021

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Background The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. Methods The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. Results One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. Conclusion The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.

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When responsive and reactive meet organic? Treatment implications of language use in the era of #BanBPSD

Macfarlane

Atee

Morris³

et al. 2021

Int J Geriat Psychiatry

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Key points The aetiopathogenesis of behaviours and psychological symptoms of dementia (BPSD) is often subjective, complex and multifaceted, produced by an array of contributing factors, including biomedical, psychological, environmental and/or social factors Alongside other contributing factors, organic aetiology of BPSD should be considered when devising therapeutic management plans Although considered last resort, time‐limited antipsychotic treatment (≤3 months) may have a vital adjunct role in managing intractable, refractory, distressing and/or life‐threatening BPSD, such as delusions and hallucinations; but only after person‐centred psychosocial interventions are exhausted and fail to deliver any therapeutic response If prescribed, careful monitoring of therapeutic responses and adverse effects of antipsychotics with de‐prescribing plans should be a top priority, as these agents have limited efficacies and serious adverse outcomes (e.g., mortality)

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Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study

Cited by 28 publications

References 23 publications

Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study

Association of polypharmacy with falls among older Chinese inpatients: A nationwide cohort study

Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences

When responsive and reactive meet organic? Treatment implications of language use in the era of #BanBPSD

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