Association between polypharmacy and falls in older adults: a longitudinal study from England

Abstract

ObjectivesAssess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.DesignLongitudinal cohort study.SettingThe English Longitudinal Study of Ageing waves 6 and 7.Participants5213 adults aged 60 or older.Main outcome measuresRates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.ResultsA total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9–2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67).ConclusionsWe found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.

Low hemoglobin A1c and low body mass index are associated with dementia and activities of daily living disability among Japanese nursing home residents with diabetes

“…Falls were associated with the total number of medications, which is consistent with previous studies . In particular, the present data showed that six or more types of medicines led to significantly higher fall risk.…”

Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder

“…Risk factors for falls/fractures include older age, poor vision, muscle weakness, difficulties with walking and balance, and the presence of various medical conditions [2,3,[6][7][8]. Polypharmacy [9][10][11] and the use of particular medications, including cumulative use of anticholinergics (termed 'anticholinergic burden'), are also known risk factors [6,7]. The interaction between these risk factors can be complex, as is seen in the relationship between anticholinergic burden and another independent risk factor, overactive bladder (OAB) [12,13].…”

Patient experiences of the burden of using medicines for long-term conditions and factors affecting burden: A cross-sectional survey

“…Polypharmacy is also of growing concern among health professionals and initiatives to reduce over-prescribing are increasing (Bokhof & Junius-Walker, 2016;Cooper et al, 2015). Polypharmacy is associated with various adverse outcomes, including increased hospitalisation, cognitive impairment, falls and drug interactions (Dalwhani et al, 2017;Guthrie, Makubate, Hernandez-Santiago, & Dreischulte, 2015;Maher, Hanlon, & Hajjar, 2014).…”