Study of fall risk-increasing drugs in elderly patients before and after a bone fracture

Beunza-Sola, Mónica; Hidalgo-Ovejero, Ángel; Martí-Ayerdi, Jon; Sánchez-Hernández, José Germán; Menendez-Garcia, Miguel; García-Mata, Serafín

doi:10.1136/postgradmedj-2017-135129

Cited by 13 publications

(27 citation statements)

References 22 publications

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“…However, the estimated 41% prevalence of suspected medication-related falls suggests that medications are a major risk factor. We have not identified other studies estimating the prevalence of medication-related falls in hip fracture patients, and we were expecting a higher occurrence of suspected medication-related falls due to the frequent use of FRIDs in hip fracture patients [10,11]. Medications can be considered modifiable risk factors, and we identified an overlap between medications found to contribute to the fall episode and medications identified as PIMs in the majority of the patients with a suspected medicationrelated fall.…”

Section: Discussionmentioning

confidence: 75%

“…The association between falls and the use of cardiovascular medications, including antihypertensives and antiarrhythmics, does not seem quite as consistent [6]. However, in clinical practice, cardiovascular medications are often regarded as FRIDs, [9,10] as their adverse effects can directly or indirectly cause dizziness, hypotension and orthostatic hypotension. Several reports have shown that more than 90% of elderly people experiencing a fall or a hip fracture are taking FRIDs [10,11].…”

Section: Introductionmentioning

confidence: 99%

“…However, in clinical practice, cardiovascular medications are often regarded as FRIDs, [9,10] as their adverse effects can directly or indirectly cause dizziness, hypotension and orthostatic hypotension. Several reports have shown that more than 90% of elderly people experiencing a fall or a hip fracture are taking FRIDs [10,11]. Thus, FRIDs can be regarded as a modifiable risk factor.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

et al. 2020

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Background: Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods: We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons' Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results: FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions: The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

et al. 2020

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“…The results of the observational studies categorized according to the strength of the study design to capture changes in FRID use after a fall‐related injury are provided in Table . In the first group of studies, FRID use was measured at admission, as well as time points following discharge (1 month and 6 months), and no change in FRID use was found. In the second group of studies that compared FRID use at admission and discharge, one study found no change in FRID use, whereas one found a reduction in FRID use .…”

Section: Resultsmentioning

confidence: 99%

Use of Fall Risk–Increasing Drugs Around a Fall‐Related Injury in Older Adults: A Systematic Review

Hart

Phelan

et al. 2020

J American Geriatrics Society

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OBJECTIVES To examine: (1) prevalence of fall risk–increasing drug (FRID) use among older adults with a fall‐related injury, (2) which FRIDs were most frequently prescribed, (3) whether FRID use was reduced following the fall‐related healthcare episode, and (4) which interventions have reduced falls or FRID use in older adults with a history of falls. DESIGN Systematic review. PARTICIPANTS Observational and intervention studies that assessed (or intervened on) FRID use in participants aged 60 years or older who had experienced a fall. MEASUREMENTS PubMed and EMBASE were searched through June 30, 2019. Two reviewers independently extracted data and evaluated studies for bias. Discrepancies were resolved by consensus. RESULTS Fourteen of 638 articles met selection criteria: 10 observational studies and 4 intervention studies. FRID use prevalence at time of fall‐related injury ranged from 65% to 93%. Antidepressants and sedatives‐hypnotics were the most commonly prescribed FRIDs. Of the 10 observational studies, only 2 used a design adequate to capture changes in FRID use after a fall‐related injury, neither finding a reduction in FRID use. Three randomized controlled studies conducted in various settings (hospital, emergency department, and community pharmacy) with 12‐month follow‐up did not find a reduction in falls with interventions to reduce FRID use, although the study conducted in the community pharmacy setting was effective in reducing FRID use. In a nonrandomized (pre‐post) intervention study conducted in an outpatient geriatrics clinic, falls were reduced in the intervention group. CONCLUSIONS Limited evidence indicates high prevalence of FRID use among older adults who have experienced a fall‐related injury and no reduction in overall FRID use following the fall‐related healthcare encounter. There is a need for well‐designed interventions to reduce FRID use and falls in older adults with a history of falls. Reducing FRID use as a stand‐alone intervention may not be effective in reducing recurrent falls. J Am Geriatr Soc 68:1334–1343, 2020.

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“…The prevalence of suspected medication-related falls is about 41% [ 555 ] to 49% [ 556 ]. Increased risk of falls was documented in users of anxiolytics/hypnotics, opioids, sedatives, antihypertensives (especially alpha-blockers), antidepressants, antiparkinsonian medications, antiepileptics and antiarrhythmics [ 557 , 558 , 559 , 560 , 561 , 562 , 563 , 564 , 565 , 566 , 567 , 568 , 569 , 570 , 571 , 572 , 573 , 574 , 575 , 576 , 577 , 578 , 579 , 580 , 581 , 582 , 583 ]; polypharmacy is strongly associated with injurious falls and fractures [ 574 , 582 , 584 , 585 , 586 , 587 , 588 ].…”

Section: Hpi-associated Chronic Extra-gastroduodenal Diseases Medmentioning

confidence: 99%

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

Fisher

Smith

2020

JCM

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Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world’s population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI–OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.

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Study of fall risk-increasing drugs in elderly patients before and after a bone fracture

Abstract: The use of FRIDs among patients with a fall-related fracture is very high. This use rises 1 month after the fracture, significantly in the case of hypnotics and antidepressants.

Cited by 13 publications

References 22 publications

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Use of Fall Risk–Increasing Drugs Around a Fall‐Related Injury in Older Adults: A Systematic Review

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

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