Using pharmacy dispensing data to predict falls in older individuals

Abstract

Aims: Associations between individual medication use and falling in older individuals are well-documented. However, a comprehensive risk score that takes into account overall medication use and that can be used in daily pharmacy practice is lacking. We, therefore, aimed to determine whether pharmacy dispensing records can be used to predict falls. Methods: A retrospective cohort study was conducted using pharmacy dispensing data and self-reported falls among 3454 Dutch individuals aged ≥65 years. Two different methods were used to classify medication exposure for each person: the drug burden index (DBI) for cumulative anticholinergic and sedative medication exposure as well as exposure to fall risk-increasing drugs (FRIDs). Multinomial regression analyses, adjusted for age and sex, were conducted to investigate the association between medication exposure and falling classified as nonfalling, single falling and recurrent falling. The predictive performances of the DBI and FRIDs exposure were estimated by the polytomous discrimination index (PDI). Results: There were 521 single fallers (15%) and 485 recurrent fallers (14%). We found significant associations between a DBI ≥1 and single falling (adjusted odds ratio: 1.30 [95% confidence interval {CI}: 1.02-1.66]) and recurrent falling (adjusted odds ratio: 1.60 [95%CI: 1.25-2.04]). The PDI of the DBI model was 0.41 (95%CI: 0.39-0.42) and the PDI of the FRIDs model was 0.45 (95%CI: 0.43-0.47), indicating poor discrimination between fallers and nonfallers. Conclusion: The study shows significant associations between medication use and falling. However, the medication-based models were insufficient and other factors should be included to develop a risk score for pharmacy practice. K E Y W O R D S dispensing records, drug burden index, elderly, fall risk-increasing drugs, falling, risk prediction The authors confirm that the Principal Investigator for this paper is Marcel Bouvy and that he had direct clinical responsibility for participants.

Association of the Drug Burden Index (DBI) exposure with outcomes: A systematic review

“…Full‐text articles were sought and screened for 316 articles that appeared to meet the inclusion criteria. Seventy studies 6,13–81 were included in the systematic review (Figure 1).…”

“…The details of the included studies are summarized in Supplementary Table S1. There were 65 studies conducted in humans 6,13–76 and five in animals (mice) 77–81 . Of the studies conducted in humans, there were 38 cross‐sectional studies, 14 retrospective cohort studies, 11 prospective cohort studies, one case–control study, and one mixed prospective/retrospective cohort study.…”

Development of the ADFICE_IT Models for Predicting Falls and Recurrent Falls in Community-Dwelling Older Adults: Pooled Analyses of European Cohorts With Special Attention to Medication

“…Predictors that had not been included in earlier models for recurrent falls were medication-related (ie, use of anti-Parkinson drugs, use of drugs for urinary frequency and incontinence, and use of antihistamines). Previous studies reporting prediction models for falls and recurrent falls have generally not considered a wide range of FRIDs as candidate predictors ( 9 ), although exceptions exist ( 12 , 18 , 19 , 53 ). Almost all medications included as predictors in our final models for predicting any fall and recurrent falls (ie, antiepileptics, drugs for urinary frequency and incontinence, and antihistamines) were classified as FRIDs by panelists in a recent Delphi consensus study ( 54 ).…”