#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Drugs as a significant risk factor for falls in geriatric patients


Authors: Jana Michalcová 1;  Katarína Bielaková 2;  Karel Vašut 1
Authors‘ workplace: Ústav aplikované farmacie FaF MU Brno 1;  Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno 2
Published in: Geriatrie a Gerontologie 2021, 10, č. 2: 68-73
Category: Original Article

Overview

Background. Falls are common undesirable events for older adults in health care institutions. Medication-related risk can be one of the leading cause of falls.

Methods. This retrospective study used medication data of older adults (n = 188) who had experienced at least one fall during stay in health care institution (n = 128 hospital ward, n =  60 nursing home) within a 2-year study period. Medicines used were classified into three risk categories (high, moderate and none) according to the fall risk information in statutory summaries of product characteristics. The fall risk categorization incorporated the relative frequency of such adverse drug effects that were known to be connected to fall risk: sedation, orthostatic hypotension, syncope, dizziness, drowsiness, changes in blood pressure and impaired balance.

Results. The fall-experienced patients in health care institutions used altogether 1748 medicaments, including 216 different active substances. Of the active substances, 102 (47 %) were categorized as high risk (category A) for increasing fall risk. Fall-experienced patients received a mean of 3.8 category A medicines (n = 710), 53 % (n = 375) of which affected the nervous and 40 % (n = 281) the cardiovascular system.

Conclusion. The preliminary categorization of fall-risk-increasing drugs and optimization of this pharmacotherapy can help to prevent the fall risk in geriatric patients.

Keywords:

geriatric patient – fall risk – medication – preventive risk management


Sources
  1. Huang AR, Mallet L, Rochefort CM, et al. Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging 2012; 29(5): 359–376.
  2. Weil TP. Patient falls in hospitals. An increasing problem. Geriatr Nurs 2015; 36(5): 342–347.
  3. Tinetti ME, Kumar C. The patient who falls: it is always a trade-off. JAMA 2010; 303(3): 258–266.
  4. Burns Z, Khasnabish S, Hurley AC, et al. Classification of injurious fall severity in hospitalized adults. J Gerontol A Biol Sci Med Sci 2020.
  5. Vaapio SS, Salmine MJ, Ojanlatva A, et al. Quality of life as an outcome of fall prevention interventions among the aged: a systematic review. Eur J Public Health 2009; 19(1): 7–15.
  6. World Health Organization. WHO Global Report on falls prevention in older age. 2008.
  7. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75(1): 51–61.
  8. Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and phamacodynamics: basic principles and practical application. Br J Clin Pharmacol 2003; 57(1): 6–14.
  9. Turnheim K. When drug therapy gets old. Pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38(8): 843–853.
  10. Wooten JM. Pharmacotherapy considerations in elderly adults. South Med J 2012; 105(8): 437–445.
  11. Jung D, Shin S, Kim H. A fall prevention guideline for older adults living in long-term care facilities. Int Nurs Rev 2014; 61(4): 525–533.
  12. Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly woman and chronic diseases and drug use: cross sectional study. BMJ 2003; 327(7417): 712–717.
  13. Neutel CI, Perry S, Maxwell C. Medication use and risk of falls. Pharmacoepidemiol Drug Saf 2002; 11(2): 97–104.
  14. World Health Organization. Medication Safety in Polypharmacy: technical report 2019. Dostupné z: https://apps.who.int/iris/handle/10665/325454.
  15. Ziere G, Dieleman JP, Hofman A, et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006; 61(2): 218–223.
  16. Glab KL, Wooding FG, Tuiskula KA. Medication-related falls in the elderly: mechanism and prevention strategies. Consult Pharm 2014; 29(6): 413–417.
  17. Darowski A, Dwight J, Reynolds J. Medicines and Falls in Hospital: Guidance Sheet. 2011. Dostupné z: www.shropshireccg.nhs.uk/media/2475/guidance-sheet-medicines-and-falls-in-hospital.pdf.
  18. Ensrud KE, Blackwell TL, Mangione, CM, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 2002; 50(10): 1629–1637.
  19. McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004; 56(2): 163–184.
  20. Leipzig RM, Cumming RG, Tinetti, ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; 47(1): 30–39.
  21. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999; 47(1): 40–50.
  22. Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009; 169(21): 1952–1960.
  23. Bloch F, Thibaud M, Dugue B, et al. Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J Aging Health 2011; 23(2): 329–346
  24. Seppala LJ, Wermelink AMAT, de Vries M, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics. J Am Med Dir Assoc 2018; 19(4): 371.
  25. de Vries M, Seppala LJ, Daams JG, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: I. Cardiovascular Drugs. J Am Med Dir Assoc 2018; 19(4): 371.
  26. Seppala LJ, van de Glind EMM, Daams JG, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: III. Others. J Am Med Dir Assoc 2018; 19(4): 372.
  27. Yoshikawa A, Ramirez G, Smith MA, et al. Opioid use and the risk of falls, fall injuries and fractures among older adults: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2020.
  28. Michalcova J, Vasut K, Airaksinen M, et al. Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC Geriatr 2020; 20: 454.
  29. Maly J, Dosedel M, Vosatka J, et al. Pharmacotherapy as major risk factor of falls – analysis of 12 months experience in hospitals in South Bohemia. J Appl Biomed 2019; 17(1): 53–60.
  30. Seppala LJ, van der Velde N, Masud T, et al. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on knowledge dissemination, management, and future research. Eur Geriatr Med 2019; 10: 275–283.
  31. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial Intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821–827.
  32. Luiting S, Jansen S, Seppälä LJ, et al. Effectiveness of cardiovaslular evaluations and interventions on fall risk: a scoping review. J Nutr Health Aging 2019; 23 (4): 330–337.
Labels
Geriatrics General practitioner for adults Orthopaedic prosthetics
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#