Background Geriatric falls are leading causes of hospital trauma admissions and injury-related deaths. Medication use is a crucial element among extrinsic risk factors for falls. To reduce fall risk and the prevalence of adverse drug reactions, potentially inappropriate medication (PIM) lists are widely used. Objective Our aim was to investigate the possible predictors of geriatric falls annualized over a 5-year-long period, as well as to evaluate the medication use of nursing home residents. Setting Nursing home residents were recruited from the same institution between 2010 and 2015 in Szeged, Hungary. Method A retrospective epidemiological study was performed. Patient data were analysed for the first 12 months of residency. Chi-squared test and Fisher's-test were applied to compare the categorical variables, Student's t test to compare the continuous variables between groups. Binary logistic regression analysis was carried out to determine the association of falls with other variables found significant in univariate analysis. Microsoft Excel, IBM SPSS Statistics (version 23) and R (3.2.2) programs were used for data analysis. Main outcome measure Falls affected by age, gender, number of chronic medications, polypharmacy, PIM meds. Results A total of 197 nursing home residents were included, 150 (76.2%) women and 47 (23.8%) men, 55 fallers (annual fall prevalence rate was 27.9%) and 142 non-fallers. Gender was not a predisposing factor for falls (prevalence in males: 23.4 vs 29.3% in females, p > 0.05). Fallers were older (mean years ± SD; 84.0 ± 7.0) than non-fallers (80.1 ± 9.3, p < 0.01). The age ≥80 years was a significant risk factor for falls (p < 0.001). The number of chronic medications was higher in male fallers (12.4 ± 4.0) than in non-fallers (6.9 ± 4.2, p < 0.001). Polypharmacy (taking four or more chronic medications) was a significant risk factor of falls (p < 0.01). Those PIMs carrying fall risk were taken by 70.9% of fallers and 75.3% of non-fallers (p > 0.05). Taking pantoprazole, vinpocetine or trimetazidine was a significant risk factor for falls. Conclusion Older age, polypharmacy and the independent use of pantoprazole, vinpocetine, and trimetazidine were found to be major risk factors for falls. Further real-life epidemiological studies are necessary to confirm the role of particular active agents, and to help professionals prescribe, evaluate and review geriatric medication use.

Aims To analyse glucose‐lowering drug utilization, focusing on the novel glucose‐lowering drug groups dipeptidyl peptidase‐4 inhibitors, glucagon‐like peptide‐1 receptor agonists and sodium‐glucose co‐transporter‐2 inhibitors, and the financial burden they entail. Methods Crude reimbursed national drug utilization and expenditure data for the entire population of Hungary were obtained from the National Health Insurance Fund for the study period: 2008 to 2017. Data were analysed using the WHO's Anatomical Therapeutic Chemical Classification/defined daily dose system and were expressed in defined daily dose per 1000 inhabitants per day. Results Total glucose‐lowering drug consumption in Hungary showed an 18% increase over the study period, reaching 74.7 defined daily doses per 1000 inhabitants per day, while novel glucose‐lowering drug use increased to 11.7 defined daily doses per 1000 inhabitants per day (16% of total glucose‐lowering drug use) by 2017. Dipeptidyl‐peptidase 4 inhibitor consumption grew to 7.4 defined daily doses per 1000 inhabitants per day by 2017. The most widely used dipeptidyl‐peptidase 4 inhibitor was sitagliptin. Glucagon‐like peptide‐1 receptor agonists were used the least, but by 2017 rose to 1.5 defined daily doses per 1000 inhabitants per day, led by liraglutide. Sodium‐glucose co‐transporter‐2 inhibitors appeared in the utilization data in 2014 and their consumption, mainly empagliflozin, reached 2.8 defined daily doses per 1000 inhabitants per day by 2017. The total expenditure on glucose‐lowering drugs increased 94% between 2008 and 2017, and the total cost of novel glucose‐lowering drug utilization comprised 44% of the total glucose‐lowering drug expenditure in 2017. Conclusions Both the use of and the financial burden posed by novel glucose‐lowering drugs in Hungary increased steadily between 2008 and 2017. This increase is expected to continue.

BackgroundOral anticoagulants (OAC) play a crucial role in preventing thromboembolic diseases. However, these medications may carry numerous problems and risks while applied. Patients taking oral anticoagulants may have a higher risk of bleeding during a surgical intervention.PurposeOur aim was to analyse the risks that patients on oral anticoagulant therapy may have during their hospitalisation and surgical procedure.Material and methodsPatients were recruited from the traumatology department, admitted with osteoporotic hip fractures. A retrospective analysis was performed for the period between January 2011 and August 2012. Data were recorded from the patient charts and documentation. Data comparison was made regarding the risks of patients on OAC and of patients not taking oral anticoagulants (control group).Results510 patients were enrolled in this study (133 males, 377 females), mean age 79.68 ± 9.81 years (mean ± SD). On admission, 49 patients were taking OAC (14 males, 35 females, mean age 80.88 ± 10.04 years), which was acenocumarol. 119 men and 342 women (mean age 79.56 ± 7.22 years) were included in the control group. In the OAC group, more time elapsed between the admission date and the surgical procedure: 3.43 days (±2.30 days) versus 1.74 days (±2.21 days) in the control group (p ≤ 0.001). At the same time, there was no substantial difference in the length of operation between the two groups: 1 h 54 min versus 1 h 50 min. Following the surgical intervention, the mean length of hospital stay did not differ significantly between the two groups (11.24 days). Complications during the surgical procedure and/or hospital stay occurred in 57.1% in the OAC group and in 51.8% of controls. During the hospital stay, 53.1% of the OAC group received blood transfusion compared with 45.3% of the control group. Mortality rate was 8.16% in OAC patients versus 3.14% in the control group. Autopsy confirmed cause of mortality was not available.ConclusionAlthough the overall hospital stay did not differ significantly, considerable differences were seen regarding length of time elapsed until surgery, complication rate and mortality rate between the OAC and control groups. The higher mortality rate highlights the frailty of patients receiving oral anticoagulant therapy.No conflict of interest.

BackgroundAnaemia is a common, multifactorial condition among elderly patients and associated with harmful consequences regarding hospitalisation, morbidity and mortality.PurposeThe aim of the study was to assess the prevalence of anaemia among elderly, hospitalised patients, and to compare the anaemic and non-anaemic patient group to determine which possible factors are associated with the development of this condition.Material and methodsPatients (≥65 years) admitted and operated with low energy, osteoporotic hip fractures from January 2011 to December 2012 were included. Anaemia was detected according to WHO criteria (haemoglobin level below 130 g/L in males and below 120 g/L in females). A retrospective analysis was performed on data recorded from the patient charts and documentation, including the following information: baseline patient characteristics, blood count outcome before surgery, chronic medications and 3 month mortality.ResultsFour hundred and twenty-one patients met the inclusion criteria (100 males, 321 females; mean age: 81.97±7.28 years). Two hundred and eleven patients (50.12%) were anaemic at admission and 20.9% of the patients had moderate or severe anaemia. The prevalence of anaemia was significantly higher among males, than females (62% vs. 46.42%; p=0.009). Among the anaemic group female patients more often suffered from moderate or severe anaemia than male patients. The presence of anaemia was increasing with age. The prevalence of polypharmacy was 80.09% and anaemic patients were taking significantly more chronic medications than non-anaemic patients (7.71 vs. 6.58; p=0.002). Proton pump inhibitor use was significantly higher among anaemic patients (36.49% vs. 26.19%; p=0.029). 65.4% of the anaemic patients and 30.95% of the non-anaemic patients received blood transfusion during the hospital stay. Thirty-six patients (8.55%) died within 3 months after hospital admission and there was no difference between anaemic and non-anaemic groups.ConclusionThe prevalence of preoperative anaemia was high among the studied patients. Although hip fracture itself may slightly contribute to anaemia, there can be numerous factors and underlying causes of anaemia. It is important to reveal the causes of anaemia and treat it accordingly.No conflict of interest

BackgroundAll antibiotics were categorised into access, watch and reserve groups in the latest List of Essential Medicines by the WHO.1 Antibiotics belonging to the reserve group should be protected and kept as a last resort when all others fail to give therapeutic effect.PurposeTo map the consumption of reserve class antibiotics during the past 5 years.Material and methodsThe study was done on reserve group antibiotics which were selected based on the WHO definition. National data, regarding distribution to hospitals, were collected from wholesales statistics for the period between 2012 and 2016. Additionally, regional consumption data for 2016 were collected. Antibiotic use was analysed according to the Anatomical Therapeutic Chemical – Defined Daily Dose method (version 2017) and expressed in DDD per 100 patient-days.ResultsDuring the study period an increase in the national use of reserve antibiotics from 0.13 to 0.26 DDD per 100 patient-days could be observed. This corresponds to a relative increase from 0.57% to 1.13% in the total use of antibiotics in the hospital. A noticeable increase in the use of colistine (from 0.09 to 0.19 DDD per 100 patient-days) and tigecycline (from 0.01 to 0.03 DDD per 100 patient-days) accounts for a great part of this upward trend. A huge variation in the regional use of reserve group antibiotics were also detected (mean: 0.26; min: 0.02; max: 1.08 DDD per 100 patient-days). Three out of four counties providing tertiary care were among the top consumers of these antibiotics.ConclusionThough the collected data is a crude measure, it shows a trend in the increase (roughly doubled) in the absolute and relative use of reserve antibiotics nationally. This trend could be explained by several factors, as an increase in antibiotic resistance and increased access of these drugs. The detected large regional variations require further research. Since these antibiotics belong to the last-line treatment options, tight monitoring is essential, to maintain their therapeutic value.Reference and/or Acknowledgements1. WHO Model List of Essential Medicines, 20th List, World Health Organisation, 2017.No conflict of interest