Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series

Wang, Grace Hsin-Min; Man, Kenneth K C; Chang, Wen-Teng; Liao, Teh‐Lu; Lai, Edward Chia‐Cheng

doi:10.1136/bmj.n1925

Cited by 17 publications

(22 citation statements)

References 52 publications

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“…However, it may not only be the medication itself that causes the risk of falling or a future hip fracture. In a study from Taiwan, the risk of falling was highest in the period before starting antipsychotic drugs [ 31 ]. This may also be the case for analgesics, which on the one hand may increase dizziness, but on the other hand may ease pain and difficulty related to moving about and thereby reduce fall risk.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of fallers who later sustain a hip fracture: a NOREPOS study

et al. 2022

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Fall prevention programs have shown inconclusive results concerning hip fracture reduction. We found that fallers with poor health, low societal participation, and use of psychotropics/painkillers had a threefold to fivefold increased hip fracture risk compared to non-fallers without these risk factors. This may help target fall prevention towards high-risk individuals. Introduction To investigate whether self-reported information on health, societal participation, and drug use in older people, easily obtainable by health care providers, contribute to predict future hip fracture beyond self-reported falls. Methods We used data from 3801 women and 6439 men aged 70-79 years participating in population-based studies in five counties in Norway 2000-2003. Height and weight were measured. Socioeconomic status, lifestyle, health status, and history of falling were self-reported through questionnaires. Falls last year were dichotomized into one or more versus no falls. Hip fractures were identified by linkage to hospital data with follow-up through 2013. Hazard ratios (HR) with 95% confidence intervals (95% CI) for hip fracture by combinations of risk factors with history of falling were estimated using Cox proportional hazards regression. Results More women (32.4%) than men (27.7%) reported one or more falls during the previous year, and 17.9% of women (n = 682) and 8.9% of men (n = 572) suffered a hip fracture during median 11.6 years of follow-up. Poor health, low societal participation, and use of psychotropics/analgesics among fallers were strong predictors of hip fracture. The presence of all three risk factors and history of falling was associated with HR 2.92 (95% CI 2.10-4.05) for hip fracture in women and HR 4.60 (95% CI 2.71-7.81) in men compared to non-fallers without these factors. Conclusion Our study indicates that self-assessment of health, information about activities outside home, and drug use among fallers far better identify high risk of hip fracture in older people than information about falls alone.

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Section: Discussionmentioning

confidence: 99%

Characteristics of fallers who later sustain a hip fracture: a NOREPOS study

et al. 2022

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“… 6 , 7 However, medication might indirectly improve fall risk by treating the underlying psychiatric disorder. 8 Psychiatric patients have higher mobility than medical inpatients, which puts them at risk for falling. Among patients with severe psychiatric illness, there is decreased self-care which can influence fall risk by malnutrition, dehydration, and muscle atrophy.…”

Section: Introductionmentioning

confidence: 99%

Falls Among Psychiatric Inpatients: A Systematic Review of Literature

Carpels¹,

Smet²,

Desplenter³

et al. 2022

ALPHA PSYCHIATRY

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Background: Falls among psychiatric inpatients are common and have significant health consequences. The purpose of this study is to systematically review the published research on risk factors and consequences. Methods: PubMed and Embase were searched for relevant studies. A total of 18 studies were included in this systematic review. The heterogeneity and low quality of the reviewed studies limit the generalizability of the results. Results: Several intrinsic and extrinsic factors are reported. Some of these factors are unique to psychiatric inpatients such as acute mental state, psychotic symptoms, and bipolar disorder leading to cognitive distortions and risk-taking; psychotropic medications inducing side effects like sedation and orthostatic hypotension; while others are similar to those found among general medical inpatients. Conclusion: Given the clinical importance of a fall and its implication on residential treatment, there is a need for targeted fall prevention programs. In order to further identify and quantify these risks and consequences, prospective research and additional study designs, describing and recording risk factors in a systematic and standardized way with the underlying etiological processes in mind, are needed.

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Section: Discussionmentioning

confidence: 99%

“…Second, we partitioned the observation time, by day, from the date of potassium supplementation initiation (i.e., t0 b ) through 150 days after t0 b , and utilized the Medicare Part D claims data to understand the daily treatment scenarios of each patient (Figure S1). 45,46 Mutually exclusive treatment scenarios included (1) loop diuretics alone; (2) potassium supplementation alone; (3) a combination of loop diuretics and potassium supplementation; (4) neither. While scenarios 1, 3, and 4 are clinically appropriate, scenario 2 (i.e., relic) may be associated with unnecessary drug use.…”

Section: Methodsmentioning

confidence: 99%

Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

Wang

Morris

Smith

et al. 2022

J American Geriatrics Society

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Background The use of a new medication (e.g., potassium supplementation) for managing a drug‐induced adverse event (e.g., loop diuretic‐induced hypokalemia) constitutes a prescribing cascade. However, loop diuretics are often stopped while potassium may be unnecessarily continued (i.e., relic). We aimed to quantify the occurrence of relics using older adults previously experiencing a loop diuretic‐potassium prescribing cascade as an example. Methods We conducted a prescription sequence symmetry analysis using the population‐based Medicare Fee‐For‐Service data (2011–2018) and partitioned the 150 days following potassium initiation by day to assess the daily treatment scenarios (i.e., loop diuretics alone, potassium alone, combination of loop diuretics and potassium, or neither). We calculated the proportion of patients developing the relic, proportion of person‐days under potassium alone, the daily probability of the relic, and the proportion of patients filling potassium after loop diuretic discontinuation. We also identified the risk factors of the relic. Results We identified 284,369 loop diuretic initiators who were 8 times more likely to receive potassium supplementation simultaneously or after (i.e., the prescribing cascade), rather than before, loop diuretic initiation (aSR 8.0, 95% CI 7.9–8.2). Among the 66,451 loop diuretic initiators who subsequently (≤30 days) initiated potassium, 20,445 (30.8%) patients remained on potassium after loop diuretic discontinuation, and 9365 (14.1%) patients subsequently filled another potassium supplementation. Following loop diuretic initiation, 4.0% of person‐days were for potassium alone, and daily probability of the relic was the highest after day 90 of loop diuretic initiation (5.6%). Older age, female sex, higher diuretic daily dose, and greater baseline comorbidities were risk factors for the relic, while patients having the same prescriber or pharmacy involved in the use of both medications were less likely to experience the relic. Conclusions Our findings suggest the need for clinicians to be aware of the potential of relic to avoid unnecessary drug use.

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Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series

Cited by 17 publications

References 52 publications

Characteristics of fallers who later sustain a hip fracture: a NOREPOS study

Characteristics of fallers who later sustain a hip fracture: a NOREPOS study

Falls Among Psychiatric Inpatients: A Systematic Review of Literature

Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

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