Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services

Abstract

Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

“…Study designs included observational studies (n=31), experimental studies (n=6), qualitative studies (n=2), and a methodological study (n=1) (Table 1 ). Six articles utilized data from an Australian cohort study ( 23 , 25 , 26 , 29 – 31 ), five from an Australian randomized controlled trial (RCT) ( 22 , 27 , 28 , 32 , 33 ), three from a Spanish longitudinal study ( 41 – 43 ), and three from a Chinese cross-sectional study ( 35 – 37 ). The number of participants ranged from 13 to 571,139, with a mean age range of 79.0 ± 8.8 to 89.4 ± 4.6 years.…”

“…Cross-sectional associations were described in 18 studies (Table 2 ). Fifteen studies reported univariate or bivariate associations ( 23 , 26 , 29 , 31 , 33 , 39 , 43 , 45 , 47 , 52 , 56 – 60 ); while four studies adjusted analyses for age, sex, and other variables ( 22 , 35 , 42 , 55 ). FRAIL-NH scores were associated with older age ( 35 , 39 , 47 , 55 – 57 ), female sex ( 29 , 45 , 55 – 57 ), multimorbidity ( 35 , 43 , 52 , 57 ), cognitive impairment ( 43 , 45 , 52 , 55 , 57 , 59 ), and functional dependence ( 43 , 52 ).…”

Longitudinal effects of using and discontinuing CNS medications on cognitive functioning

“…Medications acting on the central nervous system (CNS) frequently cause adverse effects, including problems with mobility, falls, and cognition in older individuals [1][2][3] . Results from longitudinal studies investigating cognitive effects of CNS medication use suggest that CNS medications may accelerate cognitive decline in older adults [4][5][6][7] , and it has been suggested that cognitive problems related to CNS medication use may be reversed by adjusting or discontinuing these medications 8 .…”

“…Effect of using CNS medications on intercept and slope of individual cognitive tests, including all four test occasions (T3-T6). Linear mixed-effect models included age, age2 , sex, and number of visits as covariates of no interest. Controls were matched on age, sex, years of education, test occasion, and sample.…”

“…= p < 0.05. Linear mixed-effect models included age, age2 , sex, and number of visits as covariates of no interest. Controls were matched on age, sex, years of education, test occasion, and sample.…”