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Cox N, Ilyas I, Roberts HC, Ibrahim K. Exploring the prevalence and types of fall-risk-increasing drugs among older people with upper limb fractures. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:106-112. [PMID: 36356045 DOI: 10.1093/ijpp/riac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/13/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Medications and specifically fall-risk-increasing drugs (FRIDs) are associated with increased risk of falls: reducing their prescription may improve this risk. This study explored patient characteristics associated with FRID use, prevalence and type of FRIDs and changes in their prescriptions among older people with arm fractures over 6 months. METHODS Observational prospective study in three fracture clinics in England. Patients aged ≥65 years with a single upper limb fragility fracture were recruited. The STOPPFall tool identified the number and type of FRIDs prescribed at baseline, 3- and 6-month follow-ups. Changes in FRID prescription were categorised as discontinued, new or exchanged. KEY FINDINGS 100 patients (median age 73 years; 80% female) were recruited. At baseline, 73% used ≥1 FRID daily (median = 2), reducing to 64% and 59% at 3 and 6 months, respectively. Those with >1 FRID prescription had a significantly higher number of co-morbidities and medications and higher rates of male gender, polypharmacy, frailty and sarcopenia. The most frequently prescribed FRIDs were antihypertensives, opioids and antidepressants. Between 0 and 3 months, 44 (60%) participants had changes to FRID prescription: 20 discontinued (opioids and antihistamines), 13 started (antidepressants) and 11 exchanged for another. Similar trends were observed at 6 months. CONCLUSION Use of FRIDs among older people with upper limb fragility fractures was high. Although overall use decreased over time, 59% were still on ≥1 FRID at the 6-month follow-up, with trends to stop opioids and start antidepressants. Older people presenting with upper limb fractures should be offered a structured medication review to identify FRIDs for targeted deprescribing.
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Affiliation(s)
- Natalie Cox
- Academic Geriatric Medicine and the NIHR BRC Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Isra Ilyas
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine and National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine and National Institute for Health Research Applied Research Collaboration (ARC) Wessex, University of Southampton, Southampton, UK
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Shaari MS, Wahab MSA, Abdul Halim Zaki I, Alias R, Zulkifli MH, Ali AA, Zulkifli NW, Ismail FF, Hasan MH, Meilina R, Ming LC, Tan CS. Development and Pilot Testing of a Booklet Concerning Medications That Can Increase the Risk of Falls in Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:404. [PMID: 36612725 PMCID: PMC9819758 DOI: 10.3390/ijerph20010404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Background: A common contributory factor to falls is the use of medicines, especially those commonly known as “fall-risk increasing drugs” (FRIDs). The use of FRIDs is common among older people (OP). However, OP and their family caregivers (FCGs) are largely unaware of FRIDs and their risks in increasing the risk of falls (ROF). Methods: A booklet which aims to provide information on topics related to FRIDs was developed. The booklet was reviewed by a panel of 14 reviewers, and the content validity index (CVI) for each subsection of the booklet was computed. Pilot testing of the booklet utilized a pre-post intervention study design and included 50 OP and 50 FCGs as study participants. Perceived knowledge of the participants was assessed prior to and after completing the booklet. Participants’ opinions on the usefulness and usability of the booklet were also obtained. Results: The booklet contained eight sections and each subsection of the booklet had a CVI ranging from 0.93 to 1.00. Completing the booklet resulted in improved perceived knowledge scores for each perceived knowledge item among both the OP and FCG groups (all items: p-value < 0.001). The participants perceived the booklet as useful and usable, as evidenced by almost all the perceived usefulness and usability items having a score of over 4.0. Conclusions: The FRIDs booklet developed in this study had good content validity and was widely accepted by the OP and FCGs. The positive effect on the participants’ knowledge of topics related to FRIDs means that the booklet could be useful as a patient education tool to enhance FRIDs knowledge and awareness among OP and FCGs.
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Affiliation(s)
- Mohammad Suhaidi Shaari
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Mohd Shahezwan Abd Wahab
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
- Non-Destructive Biomedical and Pharmaceutical Research Centre, Smart Manufacturing Research Institute, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Izzati Abdul Halim Zaki
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Rosmaliah Alias
- Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
| | - Muhammad Harith Zulkifli
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Aida Azlina Ali
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Nur Wahida Zulkifli
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Farhana Fakhira Ismail
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Mizaton Hazizul Hasan
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam 42300, Malaysia
| | - Rulia Meilina
- Fakultas Ilmu Kesehatan, Universitas Ubudiyah Indonesia, Kota Banda Aceh 23231, Indonesia
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City 47500, Malaysia
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia
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Hart LA, Walker R, Phelan EA, Marcum ZA, Schwartz NR, Crane PK, Larson EB, Gray SL. Change in central nervous system-active medication use following fall-related injury in older adults. J Am Geriatr Soc 2022; 70:168-177. [PMID: 34668191 PMCID: PMC8742750 DOI: 10.1111/jgs.17508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Central nervous system (CNS)-active medication use is an important modifiable risk factor for falls in older adults. A fall-related injury should prompt providers to evaluate and reduce CNS-active medications to prevent recurrent falls. We evaluated change in CNS-active medications up to 12 months following a fall-related injury in community-dwelling older adults compared with a matched cohort without fall-related injury. METHODS Participants were from the Adult Changes in Thought study conducted at Kaiser Permanente Washington. Fall-related injury codes between 1994 and 2014 defined index encounters in participants with no evidence of such injuries in the preceding year. We matched each fall-related injury index encounter with up to five randomly selected clinical encounters from participants without injury. Using automated pharmacy data, we estimated the average change in CNS-active medication use at 3, 6, and 12 months post-index according to the presence or absence of CNS-active medication use before index. RESULTS One thousand five hundred sixteen participants with fall-related injury index encounters (449 CNS-active users, 1067 nonusers) were matched to 7014 index encounters from people without fall-related injuries (1751 users, 5236 nonusers). Among CNS-active users at the index encounter, those with fall-related injury had an average decrease in standard daily doses (SDDs) at 12 months (-0.43; 95% CI: -0.63 to -0.23), and those without injury had a greater (p = 0.047) average decrease (-0.66; 95% CI: -0.78 to -0.55). Among nonusers at index, those with fall-related injury had a smaller increase than those without injury (+0.17, 95% CI: +0.13 to +0.21, vs. +0.24, 95% CI: +0.20 to +0.28, p = 0.005). CONCLUSIONS The differences in CNS-active medication use change over 12 months between those with and without fall-related injury were small and unlikely to be clinically significant. These results suggest that fall risk-increasing drug use is not reduced following a fall-related injury, thus opportunities exist to reduce CNS-active medications, a potentially modifiable risk factor for falls.
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Affiliation(s)
- Laura A. Hart
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA (work completed while a post-doctoral fellow at School of Pharmacy, University of Washington, Seattle, WA)
| | - Rod Walker
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Elizabeth A. Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, and Department of Health Services, School of Public Health, University of Washington, Seattle, WA
| | - Zachary A. Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Naomi R.M. Schwartz
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Paul K. Crane
- Department of Medicine, Division of General Internal Medicine, School of Medicine; University of Washington, Seattle, WA
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA;,Department of Medicine, Division of General Internal Medicine, School of Medicine; University of Washington, Seattle, WA
| | - Shelly L. Gray
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
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Milazzo M, David A, Jung GS, Danti S, Buehler MJ. Molecular origin of viscoelasticity in mineralized collagen fibrils. Biomater Sci 2021; 9:3390-3400. [PMID: 33949363 PMCID: PMC8323817 DOI: 10.1039/d0bm02003f] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/01/2021] [Indexed: 11/21/2022]
Abstract
Bone is mineralized tissue constituting the skeletal system, supporting and protecting the body's organs and tissues. In addition to such fundamental mechanical functions, bone also plays a remarkable role in sound conduction. From a mechanical standpoint, bone is a composite material consisting of minerals and collagen arranged in multiple hierarchical structures, with a complex anisotropic viscoelastic response, capable of transmitting and dissipating energy. At the molecular level, mineralized collagen fibrils are the basic building blocks of bone tissue, and hence, understanding bone properties down to fundamental tissue structures enables better identification of the mechanisms of structural failures and damage. While efforts have focused on the study of micro- and macro-scale viscoelasticity related to bone damage and healing based on creep, mineralized collagen has not been explored at the molecular level. We report a study that aims at systematically exploring the viscoelasticity of collagenous fibrils with different mineralization levels. We investigate the dynamic mechanical response upon cyclic and impulsive loads to observe the viscoelastic phenomena from either shear or extensional strains via molecular dynamics. We perform a sensitivity analysis with several key benchmarks: intrafibrillar mineralization percentage, hydration state, and external load amplitude. Our results show an increase of the dynamic moduli with an increase of the mineral percentage, pronounced at low strains. When intrafibrillar water is present, the material softens the elastic component, but considerably increases its viscosity, especially at high frequencies. This behavior is confirmed from the material response upon impulsive loads, in which water drastically reduces the relaxation times throughout the input velocity range by one order of magnitude, with respect to the dehydrated counterparts. We find that, upon transient loads, water has a major impact on the mechanics of mineralized fibrillar collagen, being able to improve the capability of the tissue to passively and effectively dissipate energy, especially after fast and high-amplitude external loads. Our study provides knowledge of bone mechanics in relation to pathologies deriving from dehydration or traumas. Moreover, these findings show the potential for being used in designing new bioinspired materials not limited to tissue engineering applications, in which passive mechanisms for dissipating energy can prevent structural failures.
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Affiliation(s)
- Mario Milazzo
- Laboratory for Atomistic and Molecular Mechanics (LAMM), USA. and The BioRobotics Institute, Scuola Superiore Sant'Anna, Italy
| | - Alessio David
- Dipartimento di Chimica, Materiali e Ingegneria Chimica "G. Natta", Politecnico di Milano, Milano, Italy
| | - Gang Seob Jung
- Laboratory for Atomistic and Molecular Mechanics (LAMM), USA. and Computational Sciences and Engineering Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831, USA
| | - Serena Danti
- Laboratory for Atomistic and Molecular Mechanics (LAMM), USA. and The BioRobotics Institute, Scuola Superiore Sant'Anna, Italy and Department of Civil and Industrial Engineering, University of Pisa, Italy
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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Andersen CU, Lassen PO, Usman HQ, Albertsen N, Nielsen LP, Andersen S. Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study. BMC Geriatr 2020; 20:121. [PMID: 32228478 PMCID: PMC7106700 DOI: 10.1186/s12877-020-01532-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture. Methods We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons’ Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient. Results FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM. Conclusions The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.
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Affiliation(s)
- Charlotte Uggerhøj Andersen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Hussain Qassim Usman
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Nadja Albertsen
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aalborg University Hospital, Mølleparkvej 8, 9000, Aalborg, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Geriatric and Internal Medicine, Aalborg University Hospital, Aalborg, Denmark
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Hart LA, Phelan EA, Yi JY, Marcum ZA, Gray SL. Use of Fall Risk-Increasing Drugs Around a Fall-Related Injury in Older Adults: A Systematic Review. J Am Geriatr Soc 2020; 68:1334-1343. [PMID: 32064594 DOI: 10.1111/jgs.16369] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/03/2019] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine: (1) prevalence of fall risk-increasing drug (FRID) use among older adults with a fall-related injury, (2) which FRIDs were most frequently prescribed, (3) whether FRID use was reduced following the fall-related healthcare episode, and (4) which interventions have reduced falls or FRID use in older adults with a history of falls. DESIGN Systematic review. PARTICIPANTS Observational and intervention studies that assessed (or intervened on) FRID use in participants aged 60 years or older who had experienced a fall. MEASUREMENTS PubMed and EMBASE were searched through June 30, 2019. Two reviewers independently extracted data and evaluated studies for bias. Discrepancies were resolved by consensus. RESULTS Fourteen of 638 articles met selection criteria: 10 observational studies and 4 intervention studies. FRID use prevalence at time of fall-related injury ranged from 65% to 93%. Antidepressants and sedatives-hypnotics were the most commonly prescribed FRIDs. Of the 10 observational studies, only 2 used a design adequate to capture changes in FRID use after a fall-related injury, neither finding a reduction in FRID use. Three randomized controlled studies conducted in various settings (hospital, emergency department, and community pharmacy) with 12-month follow-up did not find a reduction in falls with interventions to reduce FRID use, although the study conducted in the community pharmacy setting was effective in reducing FRID use. In a nonrandomized (pre-post) intervention study conducted in an outpatient geriatrics clinic, falls were reduced in the intervention group. CONCLUSIONS Limited evidence indicates high prevalence of FRID use among older adults who have experienced a fall-related injury and no reduction in overall FRID use following the fall-related healthcare encounter. There is a need for well-designed interventions to reduce FRID use and falls in older adults with a history of falls. Reducing FRID use as a stand-alone intervention may not be effective in reducing recurrent falls. J Am Geriatr Soc 68:1334-1343, 2020.
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Affiliation(s)
- Laura A Hart
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
| | - Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, and Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Julia Y Yi
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington
| | - Zachary A Marcum
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington
| | - Shelly L Gray
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington
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9
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Juraschek SP, Simpson LM, Davis BR, Beach JL, Ishak A, Mukamal KJ. Effects of Antihypertensive Class on Falls, Syncope, and Orthostatic Hypotension in Older Adults: The ALLHAT Trial. Hypertension 2019; 74:1033-1040. [PMID: 31476905 PMCID: PMC6739183 DOI: 10.1161/hypertensionaha.119.13445] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension treatment has been implicated in falls, syncope, and orthostatic hypotension (OH), common events among older adults. Whether the choice of antihypertensive agent influences the risk of falls, syncope, and OH in older adults is unknown. ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a randomized clinical trial that compared the effects of hypertension first-step therapy on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). In a subpopulation of ALLHAT participants, age 65 years and older, we determined the relative risk of falls, syncope, OH, or a composite based on Centers for Medicare and Medicaid Services and Veterans Affairs claims, using Cox regression. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) on outcomes in Cox models adjusted for age, sex, and race. Among 23 964 participants (mean age 69.8±6.8 years, 45% women, 31% non-Hispanic black) followed for a mean of 4.9 years, we identified 267 falls, 755 syncopes, 249 OH, and 1157 composite claims. There were no significant differences in the cumulative incidences of events across randomized drug assignments. However, amlodipine increased risk of falls during the first year of follow-up compared with chlorthalidone (hazard ratio [95% CI]: 2.24 [1.06-4.74]; P=0.03) or lisinopril (hazard ratio [95% CI]: 2.61 [1.03-6.72]; P=0.04). Atenolol use (N=928) was not associated with any of the 3 individual or composite claims. In older adults, the choice of antihypertensive agent had no effect on risk of fall, syncope, or OH long-term. However, amlodipine increased risk of falls within 1 year of initiation. These short-term findings require confirmation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
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Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
| | - Lara M Simpson
- University of Texas, Health Science Center at Houston, Department of Biostatistics, Houston, TX
| | - Barry R Davis
- University of Texas, Health Science Center at Houston, Department of Biostatistics, Houston, TX
| | - Jennifer L Beach
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
| | - Anthony Ishak
- Healthcare Associates, Beth Israel Deaconess Medical Center
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA
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10
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Correa-Pérez A, Delgado-Silveira E, Martín-Aragón S, Rojo-Sanchís AM, Cruz-Jentoft AJ. Fall-risk increasing drugs and prevalence of polypharmacy in older patients discharged from an Orthogeriatric Unit after a hip fracture. Aging Clin Exp Res 2019; 31:969-975. [PMID: 30276631 DOI: 10.1007/s40520-018-1046-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with injurious falls. We aimed to estimate the prevalence of polypharmacy and FRIDS in older patients discharged from an Orthogeriatric Unit after a hip fracture surgery. METHODS This study describes the baseline findings of a 2-year retrospective cohort study. We included patients older than 80 years discharged from an Orthogeriatric Unit who were able to walk before surgery. Patient's baseline variables, total number of drugs, and FRIDS at hospital discharge were collected. RESULTS We included 228 patients. The mean number of drugs and FRIDS prescribed at discharge was 11.6 ± 3.0 and 2.9 ± 1.6, respectively. Polypharmacy was prevalent in all patients except in three: 23.3% (5-9 drugs) and 75.9% (≥ 10 drugs). Only 11 patients had no FRIDS and 35.5% were on > 3 FRIDS. The most prevalent FRIDS were: agents acting on the renin-angiotensin system (43.9%) and anxiolytics (39.9%). The number of FRIDS was higher in patients with extreme polypharmacy (3.4 ± 1.5) than in those on 5-9 drugs (1.5 ± 1.0, p < 0.05). Independent people in performing instrumental activities had lower risk of extreme polypharmacy (≥ 10 drugs) or > 3 FRIDS: OR 0.39 (95% CI 0.18-0.83) and OR 0.41 (95% CI 0.20-0.84), respectively. People living in a nursing home had higher risk of > 3 FRIDS: OR 4.03 (95% CI 1.12-14.53). CONCLUSIONS Polypharmacy and fall-risk increasing drugs are prevalent in patients discharged from orthogeriatric care after surgery for a hip fracture. Interventions on drug use at hospital discharge could have a potential impact on falls in this high-risk population.
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Affiliation(s)
- Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Crta. Colmenar Km 9.1, 28034, Madrid, Spain.
| | - Eva Delgado-Silveira
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Sagrario Martín-Aragón
- Departamento de Farmacología, Facultad de Farmacia, Universidad Complutense, Madrid, Spain
| | | | - Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Crta. Colmenar Km 9.1, 28034, Madrid, Spain
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Park HY, Kim S, Sohn HS, Kwon JW. The Association between Polypharmacy and Hip Fracture in Osteoporotic Women: A Nested Case-Control Study in South Korea. Clin Drug Investig 2019; 39:63-71. [PMID: 30306340 DOI: 10.1007/s40261-018-0716-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Polypharmacy, regarded as an indicator of potentially inappropriate medications (PIMs), may lead to a higher risk of serious health consequences in elderly patients with osteoporosis. Thus, this study aimed to analyze the association between polypharmacy and hip fracture in patients with osteoporosis because only a limited number of studies have reported on this association, with inconsistent results to date. METHODS In this nested case-control study using a population-based sample cohort, the target cases were female patients with hip fracture diagnosed with osteoporosis and aged ≥ 50 years. Polypharmacy (prescription of an average of five or more daily drugs), PIMs for hip fracture (such as benzodiazepines and glucocorticoids), Charlson Comorbidity Index (CCI) score, and other comorbidities were analyzed during the year preceding the diagnosis of hip fracture. Adjusted odds ratios (ORs) for hip fracture for the variables were also analyzed. RESULTS The cases (n = 1003) showed higher exposure rates to polypharmacy, glucocorticoids, and benzodiazepines, and had more severe comorbidity statuses compared with the controls. The ORs for hip fracture adjusted for confounders increased with polypharmacy level, with persistent statistical significance in most analyses. The ORs (95% confidence intervals), with reference to the 0 to < 1 drug group, were 1.65 (1.31-2.08) and 2.11 (1.12-3.96) for the 5 to < 10 and 10 + drug groups, respectively, with adjustment for PIMs, and 1.34 (1.04-1.72) and 1.45 (0.76-2.80) for the 5 to < 10 and 10 + drug groups, respectively, with adjustment for PIMs and CCI score. CONCLUSIONS The results suggest that polypharmacy is associated with an increased risk of hip fracture after adjustment for confounders in patients with osteoporosis. These results highlight the importance of polypharmacy management in preventing hip fractures in patients with osteoporosis.
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Affiliation(s)
- Hae-Young Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, South Korea
| | - Suji Kim
- Major in Statistics and Data Science, Daegu University, Gyeongsan-si, Gyeongbuk, 38453, South Korea
| | - Hyun Soon Sohn
- College of Pharmacy, Cha University, Sungnam-si, Kyunggi-do, 11160, South Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, South Korea.
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Silva AKM, da Costa DCM, Reis AMM. Risk factors associated with in-hospital falls reported to the Patient Safety Commitee of a teaching hospital. EINSTEIN-SAO PAULO 2019; 17:eAO4432. [PMID: 30785492 PMCID: PMC6377043 DOI: 10.31744/einstein_journal/2019ao4432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/09/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the use of fall-risk-increasing drugs among patients with falls reported to the Patient Safety Office of a hospital, and to identify the factors associated with high risk for fall. METHODS A cross-sectional study, carried out in a teaching hospital. The study population was the universe of fall reports received by the Patient Safety Office. The dependent variable was a high risk for falls. The Medication Fall Risk Score was used to measure fall risk. Descriptive, univariate and multivariate analyses were performed. RESULTS Of the 125 fall reports in the study, 38 (30.4%) were in 2014, 26 (20.8%) in 2015, and 61 (48.8%) in 2016. Half of the patients (63; 50.4%) were classified as high fall risk and 74 (59.2%) had two or more risk factors for the event. The most frequently used drug classes were opioids (25%), anxiolytics (19.7%), beta-blockers (9.9%), angiotensin II antagonists (7%) and vascular-selective calcium channel blockers (7%). After the adjusted analysis, the factors associated with falls were amputation (odds ratio: 14.17), female sex (odds ratio: 2.98) and severe pain (odds ratio: 5.47). CONCLUSION Medications are an important contributor to in-hospital falls, and the Medication Fall Risk Score can help identify patients at a high risk for falls.
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