Fall-risk-increasing drugs and falls requiring health care among older people with intellectual disability in comparison with the general population: A register study

Abstract

BackgroundFalls are the most common cause of injury for older people in the general population as well as among those with intellectual disability. There are many risk factors for falls, including a range of drugs which are considered to be fall-risk-increasing (FRIDs). The aim of the present study was to describe prescription patterns of FRIDs in itself as well as in relation to falls requiring health care among older people with intellectual disability and their age-peers in the general population. Moreover, to investigate possible differences between the two groups.MethodsA cohort of people with intellectual disability and a referent cohort, one-to-one-matched by sex and year of birth, were established. Each cohort comprised 7936 people aged 55+ years at the end of 2012. Register data were collected for 2006–2012 on prescription of antidepressants, anxiolytics, hypnotics and sedatives, opioids, and antipsychotics, as well as for fall-related health care contacts. Analyses were performed on yearly data, using repeated measures models.ResultsPeople with intellectual disability were more likely to be prescribed at least one FRID (Relative Risk [RR] 2.31). The increase was highest for antipsychotics (RR 25.0), followed by anxiolytics (RR 4.18), antidepressants (RR 2.72), and hypnotics and sedatives (RR 1.42). For opioids, however, a lower prevalence (RR 0.74) was found. In both cohorts, those with prescription of at least one FRID were more likely to have a fall-related injury that required health care. The increased risk was higher in the referent cohort (RR 3.98) than among people with intellectual disability (RR 2.27), although people with intellectual disability and prescription still had a higher risk of falls than those with prescription in the referent cohort (RR 1.27). A similar pattern was found for all drug groups, except for opioids, where prescription carried the same risk of having a fall-related injury that required health care in both cohorts.ConclusionsWith or without prescription of FRIDs, older people with ID have a higher risk of falls requiring health care than their age-peers in the general population. It is important to be aware of this when prescribing drugs that further increase the risk of falls.

Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population

“…In summation, that prescription of psychotropics is common among people with ID has been reported before, both for the cohorts included in the present study [11, 17] and in other populations [23]. The present study shows that this excess is present even when restricting the study groups to those with diagnosis of anxiety and mood disorders, and that the underlying reason for prescription must be sought elsewhere than in the prevalence of these diagnoses.…”

“…We have previously found that older people with ID are more likely than their age-peers in the general population to be prescribed anxiolytics [11] and the GABA-agonist benzodiazepine [17]. At a first glance, this may be interpreted as a result of higher occurrence of psychiatric diagnoses in this group [4].…”

“…Antipsychotic drugs are often prescribed off-label to manage behavioural impairment [8–10]. This in spite the lack of evidence of their effectiveness for this [9], and the increased risk of side effects found for them in people with ID [11, 12] which may result in a decreased quality of life [13].…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…The prevalence of suspected medication-related falls is about 41% [ 555 ] to 49% [ 556 ]. Increased risk of falls was documented in users of anxiolytics/hypnotics, opioids, sedatives, antihypertensives (especially alpha-blockers), antidepressants, antiparkinsonian medications, antiepileptics and antiarrhythmics [ 557 , 558 , 559 , 560 , 561 , 562 , 563 , 564 , 565 , 566 , 567 , 568 , 569 , 570 , 571 , 572 , 573 , 574 , 575 , 576 , 577 , 578 , 579 , 580 , 581 , 582 , 583 ]; polypharmacy is strongly associated with injurious falls and fractures [ 574 , 582 , 584 , 585 , 586 , 587 , 588 ].…”

Incidents resulting in health care among older people with intellectual disability in comparison with the general population: A national register study

“…Previous studies regarding incidents among older people with ID have mainly focused on fall-related injuries Axmon, Sandberg, Ahlström, & Midlöv, 2018;, which is not surprising, as fractures are the most common cause of hospitalisation among diagnoses of injury, poisoning, and certain other consequences of external causes (Skorpen et al, 2016). Indeed, to the best of our knowledge, only one previous study has assessed poisonings and objects stuck in part of body (Finlayson, Morrison, Jackson, Mantry, & Cooper, 2010).…”