Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units

Michalcova, Jana; Vašut, Karel; Airaksinen, Marja; Bielaková, Katarína

doi:10.1186/s12877-020-01845-9

Cited by 26 publications

(23 citation statements)

References 46 publications

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“…51 Another study, also conducted in the Portuguese population, found that the pharmacological groups of PIMs with the highest prescription were anxiolytics, more precisely derivatives of benzodiazepines, antidepressants, antipsychotics and proton-pump inhibitors. 52 Although the literature associates medication use with increased risk of falls, 53 , 54 we found no significant relationships between the presence of PIMs and the occurrence of falls.…”

Section: Discussionmentioning

confidence: 56%

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

Ferreira¹,

Mascarenhas-Melo²,

Rodrigues³

et al. 2022

PHARMPRACT

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Background: Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. Objective: This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. Methods: The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). Results: A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. Conclusions: This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.

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Section: Discussionmentioning

confidence: 56%

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

Ferreira¹,

Mascarenhas-Melo²,

Rodrigues³

et al. 2022

PHARMPRACT

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“…Partly because of possible fluctuations in blood pressure and partly because of the mechanism of drug action, cardiovascular diseases increase not only the risk but also the severity of falls [11,19,20]. The risk of falls rises by 60% when using antiarrhythmic calcium channel blockers; by 20% when taking drugs containing digoxin; and by 10% when taking diuretics [15,21]. Based on our sample data and data for the elderly population living at home, it can be stated that one in two elderly people suffer from cardiovascular disease [22].…”

Section: Chronic Diseasesmentioning

confidence: 99%

“…This increased risk is due partly to the side effects of the drugs and partly to drug interactions. The risk of falling is 66% higher when taking psychoactive drugs [21,22,37]. In terms of medication, the most common cause of falls is the regular use of antidepressants: serotonin reuptake inhibitors in particular increase the risk of falls [38].…”

Section: Chronic Diseasesmentioning

confidence: 99%

“…In terms of medication, the most common cause of falls is the regular use of antidepressants: serotonin reuptake inhibitors in particular increase the risk of falls [38]. Benzodiazepines and tranquillisers, which are taken regularly by 15% of older people, increase the risk of falls by 8% [21,37,38]. Drugs that affect the central nervous system, such as those used to treat Parkinson's disease, as well as narcotic painkillers, also increase the risk of falls.…”

Section: Chronic Diseasesmentioning

confidence: 99%

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Prevalence of risk factors for falls among older adult ambulant patients on a chronic inpatient ward

Wiesl

Kis-Kós

Gyombolai

et al. 2023

DHS

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Purpose Falls in older age are the result of the interaction of several modifiable and nonmodifiable risk factors. Risk factors for falls may vary in frequency not only in different economic and cultural contexts but also in different forms of care services among the older population. The aim of the present cross-sectional descriptive observational study was to assess the prevalence of risk factors for falls among older ambulant patients on a chronic inpatient ward in Hungary. Material/Methods Data associated with risk factors for falls, such as age, sex, chronic physical and mental illness, acute illness, incontinence, history of falls, balance and gait disorder, and visual impairment, were collected from 82 participants. The frequency of these risk factors in our sample was compared with their prevalence in the elderly population living at home — based on data available in the literature and statistical databases — using chi-square tests. Results Our results show that the prevalence of hypertension, cerebrovascular events, dementia and diabetes are significantly higher in the elderly population in chronic inpatient care than in the elderly population living at home. There is also a significantly higher prevalence of balance disorders and the use of sedatives/sleeping pills/neuroleptics in the studied population. Cardiovascular diseases, osteoporosis, and Parkinson's disease are equally prevalent in both populations. Conclusions In the case of many of the patients admitted to chronic inpatient care, there is a real chance that their physical condition will improve or stabilise to the point where they can return to their own homes or be moved to a nursing home. This kind of rehabilitation approach to chronic inpatient care would require many more qualified nurses, physiotherapists, occupational therapists, dietitians and social workers than are currently available.

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“…Also, regarding the risk factors for falls and/or fractures and in the context of clinical comorbidities, there is limited published research that seeks to establish a comprehensive model of factors that influence fall and fracture risk among elderly patients. 15,16 Given the gaps in evidence around these common adverse events associated with opioid use, this study sought to assess the frequency, time to event, and risk factors associated with a fall or fracture in a commercially insured US population of patients with OA taking opioids (ie, tramadol or non-tramadol opioids).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Falls and Fractures Following Prescription of Opioids Among Privately Insured Patients with Osteoarthritis

Silverman

Schepman

Rice

et al. 2022

Journal of Health Economics and Outcomes Research

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Background: While prior research has shown that patients with osteoarthritis (OA) who are prescribed opioids have higher rates of falls and fractures following drug initiation, there is a limited body of work establishing a comprehensive model of factors that influence the risk of falls or fractures among these patients. Objective: Opioids are associated with negative clinical outcomes, including increased risk of falls and fractures. This study assessed the frequency, treatment characteristics, and risk factors associated with falls or fractures among patients with OA taking opioids. Methods: Optum Healthcare Solutions, Inc data (January 2012–March 2017) were used to identify patients over 18 with at least 2 diagnoses of hip and/or knee OA, and at least 90 days’ supply of opioids. Patients with cancer were excluded. Falls or fractures outcomes were assessed in the 36-month follow-up period after the date of the first opioid prescription after first OA diagnosis. Demographic, treatment, and clinical characteristics associated with falls or fractures were assessed using logistic regression. Results: Of 16 663 patients meeting inclusion criteria, 3886 (23%) had at least 1 fall or fracture during follow-up. Of these 3886 patients, 1349 (35%) had at least 1 fall with an average of 3 fall claims, and 3299 (85%) patients had at least 1 fracture with an average of 8 claims during follow-up. Spine (15.8%) and hip (12.5%) fractures were most common. Median time to fall or fracture was 18.6 and 13.9 months, respectively. Significant (P<.05) risk factors associated with at least 1 fall or fracture during the follow-up period included alcohol use (odds ratio [OR], 3.41), history of falling (OR, 2.19), non-tramadol opioid use (OR, 1.31), age (OR, 1.03), benzodiazepine use (OR, 1.21), and at least 1 osteoporosis diagnosis (OR, 2.06). Discussion: This study is among only a few that clearly identifies the substantial impact and frequency of falls and fractures associated with prescribing non-tramadol opioids to patients with OA. Findings suggest that fall or fracture risks need to be considered when managing OA pain with opioids. Conclusion: Falls and fractures impose a major clinical burden on patients prescribed opioids for OA-related pain management. Falls or fracture risks should be an important consideration in the ongoing treatment of patients with OA.

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Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units

Cited by 26 publications

References 46 publications

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

Prevalence of risk factors for falls among older adult ambulant patients on a chronic inpatient ward

Risk Factors Associated with Falls and Fractures Following Prescription of Opioids Among Privately Insured Patients with Osteoarthritis

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