Exploring the prevalence and types of fall-risk-increasing drugs among older people with upper limb fractures

Detection of Falls and Frailty in Older Adults with Oldfry: Associated Risk Factors

OBJECTIVE

To describe the characteristics and outcomes of using the Oldfry technology application in older adults, analyzing changes in frailty and fall risk after its implementation.

DESIGN AND METHODS

Observational, analytical, prospective, cross-sectional, and multicenter study conducted in residential centers in Plana Baja (Castellón, Spain). A total of 156 older adults over 65 years old participated, selected based on specific criteria and voluntary consent. Sociodemographic, anthropometric, and clinical variables were collected, including fall history, sensory problems, medication use, and standardized cognitive, nutritional, and functional assessment scales. The study was approved by the Ethics Committee of Universitat Jaume I.

RESULTS

The sample included 156 individuals (median age: 84 years). Women showed greater functional dependence (Barthel scale) and cognitive impairment (Pfeiffer scale). The Oldfry device detected frailty with statistically significant differences. A direct relationship was found between greater functional dependence and higher fall risk, as well as between higher comorbidity and increased fall risk. An adequate nutritional status was associated with a lower fall risk.

CONCLUSION

The use of Oldfry is crucial for assessing frailty and fall risk in older adults. Factors such as functionality, comorbidities, and nutritional status directly influence fall prevention, highlighting the importance of technological tools in monitoring these risks.

Impact of an Interprofessional Collaboration Between Physicians and Pharmacists on Fall-Risk-Increasing Drugs in Older Patients with Trauma in the Emergency Department

Background/Objectives: In older patients, falls constitute a significant public health concern and a major cause of hospital admission. Fall-risk-increasing drugs (FRIDs) represent a key risk factor for falls. Therefore, modifying these drugs represents an important strategy for preventing recurrent falls and further patient harm. The objective of this study was to evaluate a structured interprofessional collaboration between physicians and pharmacists on managing FRIDs in older patients who present to the emergency department (ED) after a fall. Methods: This study was performed in the ED of a tertiary care hospital. Patients who were >65 years old and presented to the ED after a fall were included. A routine care group was included between 1 March 2020 and 31 May 2020. A pharmaceutical care group was included between 1 September 2023 and 30 November 2023. In the pharmaceutical care group, a clinical pharmacist supported the physicians in identifying and managing FRIDs. Possible solutions for improving FRID prescription were discussed interprofessionally. The number of FRIDs at ED admission and discharge, as well as the number of FRID modifications, were evaluated. Results: A total of 107 patients were enrolled in each group. There were 85 patients in the routine care group and 89 patients in the pharmaceutical care group, with at least 1 FRID prescribed at ED admission (p = 0.483). At ED discharge, there were 85 patients in the routine care group and 68 patients in the pharmaceutical care group, with at least 1 FRID prescribed at (p = 0.010). There were seven FRID modifications in the routine care group compared to 125 FRID modifications in the pharmaceutical care group. Conclusions: In this study, the interprofessional collaboration between physicians and pharmacists led to a reduced number of FRIDs being prescribed and more FRID modifications in older patients at ED discharge. Further research is required to ascertain the feasibility of integrating this single intervention into a multifactorial fall prevention program.

The association between falls and fall-risk-increasing drugs among older patients in out-patient clinics: A retrospective cohort, single center study

BACKGROUND

Falls among older adults are considered a significant global health concern, often leading to severe injuries and increased healthcare costs. Fall-risk-increasing drugs (FRIDs), such as opioids and benzodiazepines, have been identified as contributing factors, yet the causal relationship remains unclear. This study examined the association between FRIDs, identified using the STOPP version 2 and STOPP Fall criteria, and falls among older outpatients.

METHODS

This retrospective cohort study included 19,705 patients aged 65 and older who visited outpatient clinics at Thammasat University Hospital, Thailand, in 2021. Data were collected from electronic medical records, including demographics, public health insurance schemes, diagnoses, and prescribed medications. FRIDs were identified using section K of STOPP version 2 and STOPPFall criteria. The association between FRIDs and falls was analyzed using multiple logistic regression.

RESULTS

The prevalence of FRIDs was 33 %, with Lorazepam being the most common. The overall incidence of falls was 1.48 %. An adjusted relative risks (ARR) of falls in the participants with FRIDs was 1.35 (95 % CI: 1.03-1.76) and 1.31 (95 % CI: 1.03-1.66) according to STOPP version 2 and STOPPFall criteria, respectively. Females, patients over 70, and those with polypharmacy or frequent outpatient visits also had increased fall risks.

CONCLUSION

FRIDs are associated with an increased risk of falls among older adults in outpatient settings. These findings highlight the need for careful prescribing and monitoring of FRIDs, particularly in older patients with other fall risk factors.

Fall risk-increasing drugs and associated health outcomes among community-dwelling older patients: A cross-sectional study in Croatian cohort of the EuroAgeism H2020 project

Our study aimed to assess the prevalence of fall risk-increasing drugs (FRIDs) in a sample of community-residing older patients in Croatia and its association with negative health outcomes. An observational, cross-sectional study was conducted on older patients (65+) visiting community pharmacies in three regionally different study sites in Croatia. Data were collected using a questionnaire developed for that purpose and included components of comprehensive geriatric assessment. Prevalence of FRIDs was identified using the "Screening Tool of Older Persons Prescriptions in older adults with high fall risk" (STOPPFall). In the sample of 407 participants (median age 73 (IQR 69-70) years; 63.9 % females), 79.1 % used at least one FRID. The most common drug classes were diuretics, benzodiazepines, and opioids (in 51.1 %, 38.1 %, and 17.2 % participants, respectively). More FRIDs were prescribed to the oldest old patients (85+) and participants from poorer regions of Croatia (Slavonia) (p < 0.05). Exposition to FRIDs was identified as the significant risk factor associated with falls (OR = 1.24 (1.04-1.50); p = 0.020) and higher health-care utilization (OR = 1.29 (1.10-1.51); p = 0.001). Our study highlights the need for rationalization of FRID use. To reduce the unnecessary exposure to FRIDs in older adults, health-care professionals must consider high individualization of medication schemes regarding selection, dosing, and combinations of only necessary FRIDs.

Factors associated with fall risk increasing drug use in older black and white men and women: the Health ABC Study

BACKGROUND

Most older adults use medications that may increase falls, often defined as fall risk increasing drugs or "FRIDs". Two definitions for FRIDs, the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI-Rx) and Swedish National Board of Health and Welfare (SNBHW) definitions, are widely accepted, though include different FRIDs in their definitions. Whether factors associated with FRID use in older adults differ by definition is unknown.

METHODS

We hypothesized that factors for FRID use will vary by FRID definition in 1,352 community-dwelling older Black and White adults with medication information in the Health, Aging and Body Composition Study (Health ABC; 2007-08 clinic visit; 83.4 ± 2.8 years; 54.1% women; 65.1% White). Multivariable logistic regression and multivariable negative binomial regression, progressively entering groups of covariates (demographics, lifestyle/behavior factors, and multimorbidity), modeled FRID use (yes/no) and count.

RESULTS

Of 87.0% participants using SNBHW FRIDs, 82.9% used cardiac medications, with lower use of all other FRIDs (range:1.1-12.4%). Of 86.6% participants using STEADI-Rx FRIDs, 80.5% used cardiac medications, with lower use of all other FRIDs (range:1.1-16.1%). Participants with FRID use by either definition were more likely to have chronic health conditions, a hospitalization in the prior year, higher non-FRIDs medication counts, higher Center for Epidemiologic Studies Depression Scale (CES-D) scores, and less physical activity (all p < 0.05). Participants with STEADI-Rx FRID use had poorer vision and higher Modified Mini-Mental State (3MS) scores. In multivariable logistic regression for SNBHW use, hypertension, body mass index (BMI), 3MS scores, and non-FRID count were positively associated with FRID use and poorer vision and Digit Symbol Substitution Test (DSST) scores were negatively associated. In addition to SNBHW factors, higher CES-D scores were associated with STEADI-Rx FRID use. In multivariable negative binomial regression, hypertension, higher BMI, CES-D scores, and non-FRID count were associated with higher FRID count and sleep problems with lower FRID count for both definitions. Higher 3MS and lower DSST scores were associated with higher STEADI-Rx FRID count. Women had lower SNBHW FRID count after adjustments.

CONCLUSIONS

Risk factors for FRID use in older adults differ slightly by STEADI-Rx and SNBHW FRIDs definition, but are largely similar.

A Longitudinal Study of the Use and Effects of Fall-Risk-Increasing Drugs in Residential Aged Care

OBJECTIVES

Fall-risk-increasing drugs (FRIDs)-psychotropics and cardiovascular disease (CVD) drugs-may elevate the risk of falling, with strong evidence observed in psychotropic FRIDs, whereas findings from cardiovascular disease (CVD) FRIDs remain inconclusive. Existing studies on FRIDs and falls are often hampered by methodologic limitations. Leveraging longitudinal observational data, we aimed to determine the long-term patterns of FRID use and their association with falls in residential aged care (RAC) homes.

DESIGN

A retrospective longitudinal cohort study.

SETTING AND PARTICIPANTS

A total of 4207 permanent residents newly admitted to 27 RAC homes in Sydney, Australia.

METHOD

The outcomes were incidence of all and injurious falls. We measured exposure to each FRID over 60 months using the Proportion of Days Covered (PDC) metric. We used group-based multitrajectory modeling to determine concurrent usage patterns of psychotropics and CVD FRIDs and applied negative binomial regression to assess their associations with the outcomes.

RESULTS

A total of 83.6% (n = 3516) and 77.3% (n = 3254) residents used psychotropic and CVD FRIDs, respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α-adrenoceptor antagonists) to 89.6% (β blockers) for CVD FRIDs. We identified 4 groups: group 1, low psychotropics-low CVDs use (16.7%, n = 701); group 2, low psychotropics-high CVDs (25.0%, n = 1054); group 3, high psychotropics-high CVDs (41.0%, n = 1723); and group 4, high psychotropics-low CVDs (17.3%, n = 729). Group 4 had a significantly higher rate of falls than the other groups for both outcomes, including relative to group 3, in which exposure to both FRID classes was high.

CONCLUSIONS AND IMPLICATIONS

Our findings reveal concerningly high FRID use in RAC homes and highlight a critical difference in the impact of the 2 major FRID classes on falls. Psychotropics were strongly associated with falls, whereas the studied CVD FRIDs did not elevate risk of falling.

Polypharmacy and risk of fractures in older adults: A systematic review

BACKGROUND

Fractures have serious health consequences in older adults. While some medications are individually associated with increased risk of falls and fractures, it is not clear if this holds true for the use of many medications (polypharmacy). We aimed to identify what is known about the association between polypharmacy and the risk of fractures in adults aged ≥65 and to examine the methods used to study this association.

METHODS

We conducted a systematic review with narrative synthesis of studies published up to October 2023 in PubMed, Embase, CINAHL, PsychINFO, Cochrane Library, Web of Science, and the grey literature. Two independent reviewers screened titles, abstracts, and full texts, then performed data extraction and quality assessment.

RESULTS

Among the 31 studies included, 11 different definitions of polypharmacy were used and were based on three medication counting methods (concurrent use 15/31, cumulative use over a period 6/31, daily average 3/31, and indeterminate 7/31). Overall, polypharmacy was frequent and associated with higher fracture risk. A dose-response relationship between increasing number of medications and increased risk of fractures was observed. However, only seven studies adjusted for major confounders (age, sex, and chronic disease). The quality of the studies ranged from poor to high.

CONCLUSIONS

Polypharmacy appears to be a relevant modifiable risk factor for fractures in older individuals that can easily be used to identify those at risk. The diversity of medication calculation methods and definitions of polypharmacy highlights the importance of a detailed methodology to understand and compare results.

Baclofen and the risk of fall and fracture in older adults: A real-world cohort study

BACKGROUND

The growth of oral muscle relaxant prescriptions among older adults in the United States is concerning due to the drugs' adverse sedative effects. Baclofen is a gamma-aminobutyric acid agonist muscle relaxant that is associated with encephalopathy. We characterized the risk of fall and fracture associated with oral baclofen against other muscle relaxants (tizanidine or cyclobenzaprine) in older adults.

METHODS

We designed a new-user, active-comparator study using tertiary health system data from Geisinger Health, Pennsylvania (January 2005 through December 2018). Older adults (aged ≥65 years) newly treated with baclofen, tizanidine, or cyclobenzaprine were included. Propensity score-based inverse probability of treatment weighting (IPTW) was used to balance the treatment groups on 58 baseline characteristics. Fine-Gray competing risk regression was used to estimate the risk of fall and fracture.

RESULTS

The study cohort comprised of 2205 new baclofen users, 1103 new tizanidine users, and 9708 new cyclobenzaprine users. During a median follow-up of 100 days, baclofen was associated with a higher risk of fall compared to tizanidine (IPTW incidence rate, 108.4 vs. 61.9 per 1000 person-years; subdistribution hazard ratio [SHR], 1.68 [95% CI, 1.20-2.36]). The risk of fall associated with baclofen was comparable to cyclobenzaprine (SHR, 1.17 [95% CI, 0.93-1.47]) with a median follow-up of 106 days. The risk of fracture was similar among patients treated with baclofen versus tizanidine (SHR, 0.85 [95% CI, 0.63-1.14]) or cyclobenzaprine (SHR, 0.85 [95% CI, 0.67-1.07]).

CONCLUSIONS

The risk of fall associated with baclofen was greater than tizanidine, but not compared to cyclobenzaprine in older adults. The risk of fracture was comparable among the older users of baclofen, tizanidine, and cyclobenzaprine. Our findings may inform risk-benefit considerations in the increasingly common clinical encounters where oral muscle relaxants are prescribed.