Association of drugs with special caution in the guidelines with falls: A case–control and case–crossover study in Japan

Abstract

Aim To determine the relationship between multiple medications and falls. Methods This case–control and case–crossover study was carried out at Kudanzaka Hospital in Chiyoda, Tokyo, Japan. A total of 325 patients who experienced their first falls when hospitalized between January 2016 and November 2018, and 1285 controls matched by sex, age and clinical departments were included in this study. Hospitalization duration and fall risk score were adjusted for in the analyses. Results In the case–control study, multivariable logistic regression showed that increasing the intake of oral medications was not significantly associated with the incidence of falls (odds ratio 1.02, 95% confidence interval 0.998–1.049). In contrast, drugs prescribed with special caution in accordance with the Elderly Oral Medication Guidelines were significantly associated with falls (odds ratio 1.17, 95% confidence interval 1.09–1.26). A similar pattern was observed in the case–crossover analysis. Among the drugs to be prescribed with special caution according to the guidelines, atypical antipsychotics, non‐benzodiazepine hypnotics and magnesium oxide were significantly associated with the risk of falls. Conclusion The drugs to be prescribed with special caution according to the guidelines were associated with an increased fall risk. The risk of falls in hospitalized older people due to multiple medications varies among medications. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2021; ••: ••–••.

Evaluating the use of methods to mitigate bias from non‐transient medications in the case‐crossover design: A systematic review

“…Of the 114 included articles, the case‐crossover design was the most common (100, 88%), 18–117 followed by the case‐time‐control (19, 17%), 38,63,67,71,86,118–131 and case‐case‐time‐control (4, 3%) 33,47,48,86 . (Table 1) The most common outcomes measured in these studies were hospitalization (43, 38%), cardiovascular events (22, 19%) and fall‐related injury/fracture (15, 13%).…”

“…Among the one‐third of studies that evaluated multiple medications, half of those evaluated both transient and non‐transient medications 21,22,25,32,39,47,52,70,88,105,122,126,128,129 . Only one study varied the risk window length across different medications 88 while the remainder used the same risk window to evaluate all medications.…”

“…Only one study varied the risk window length across different medications 88 while the remainder used the same risk window to evaluate all medications. Half of the studies that evaluated both kinds of medications were published in 2021, an abrupt increase in the use of the case‐crossover design to evaluate both kinds of medications 21,22,25,52,126,128 . Different exposure‐outcome pairs may have different induction, latency, effect, and carry‐over periods 132 .…”

“…Among the one-third of studies that evaluated multiple medications, half of those evaluated both transient and non-transient medications. 21,22,25,32,39,47,52,70,88,105,122,126,128,129 Only one study varied the risk window length across different medications 88 while the remainder used the same risk window to evaluate all medications. Half of the studies that evaluated both kinds of medications were published in 2021, an abrupt increase in the use of the case-crossover design to evaluate both kinds of medications.…”

“…Half of the studies that evaluated both kinds of medications were published in 2021, an abrupt increase in the use of the case-crossover design to evaluate both kinds of medications. 21,22,25,52,126,128 Different exposure-outcome pairs may have different induction, latency, effect, and carry-over periods. 132 The length of risk window should be decided based on a biologically plausible relationship between exposure and outcome.…”