Medication and falls in elderly outpatients: an epidemiological study from a German Pharmacovigilance Network

Abstract

The aim of this study was to investigate the relationship between fall risk increasing drugs (FRIDS) and the risk of falls in regard to fall-related chronic diseases. In total, 39 primary care physicians in Germany participated in the EvaMed Pharmacovigilance Network. Antihypertensives, non-steroidal anti-inflammatory drugs, hypnotics and sedatives, antidepressants and psycholeptics were labelled as FRIDS. A fall was defined according to a diagnosis in the chapter Injury or poisoning (S00-T14 in International Statistical Classification of Diseases 10th Revision (ICD-10)). Patients older than or equal to 65 years with at least two doctor’s visits were included. FRIDS were prescribed for 1768 patients from a total of 5124 patients included in the analysis. FRIDS and seven chronic diseases were statistically significant associated with a higher risk of experiencing a fall. The risk was highest for patients with a diagnosis abnormalities of gait and mobility, vertigo, visual -impairment and weight loss, and increased by 50-90% with arthritis, diseases of arteries, arterioles and capillaries and heart failure. From patients (N = 425) with at least one diagnosis of fall, 219 patients were prescribed FRIDS. In 100 (45.7%) of cases the diagnoses for fall were made before and in 105 (47.9%) of cases at least a month after the prescription of FRIDS. 14 (6.4%) patients had a prescription of FRIDS and a diagnosis of fall within one month. Perceptual disorders, low walking speed and pain are prominent predictors for falls in the elderly. A prescription of FRIDS selects more vulnerable patients having a higher risk of falls. However, experiencing a fall is mainly due to the disease followed by treatment. Thus, not prescribing FRIDS will avoid only a small number of falls.

Predicting Falls in People Aged 65 Years and Older from Insurance Claims

“…Additionally, the guidelines recommend checking for orthostatic hypotension, visual impairment, and cognitive impairment as well as review of psychoactive medications. However, use of the guidelines relies on in-person clinical evaluation and often only takes into account a small portion of the risk factors among medications, 7–10 diagnoses, 8,11 and social issues. 12 .…”

Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol

“…Sample size was calculated according to the best-found evidence at the moment of the study design: a study conducted in a community setting with patients older than 65 years (mean age 73 years) who went to a primary care center due to a fall, and were followed for 2 years. 26 According to this study, the risk of falling was 12.4% and 6.1% for those patients who have been using FRIDS and for those patients who have not been, respectively. Supposing a higher risk of falling for the participants in our study, as they are 80 years old or more and have suffered from a previous hip fracture, we estimate, considering the same proportion of risk as in the aforementioned study, that 40% of patients in treatment with FRIDS and 20% without FRIDS will fall.…”

Cardiovascular Disorders and Falls Among Older Adults: A Systematic Review and Meta-Analysis

“…Fifteen studies showed no association: QA 6.9 (range 4–10) ( 33 , 37 , 60 , 61 , 67 , 68 , 76 , 81 , 83 , 85 , 88 , 129 , 168 , 171 , 176 ). Eight identified a positive association: QA 6.8 (range 4–8) ( 40 , 47 , 49 , 51 , 59 , 100 , 169 , 177 ) ( Supplementary Table 7 ).…”

“…Seventeen studies reported no association: QA 7.2 (range 5–10) ( 35 , 38 , 53 , 54 , 64 , 82 , 86 , 89 , 109 , 112 , 125 , 126 , 156 , 209–212 ). Thirteen reported a positive association: QA 6.9 (range 4–8) ( 47 , 65 , 66 , 69 , 74 , 94 , 102 , 163 , 172 , 177 , 206 , 213 , 214 ) ( Supplementary Table 13 ). The majority of studies reported no association with falls.…”

“…It is difficult to make any clinical recommendations in these instances given the lack of specificity of these terms. Similarly, there was a lack of clinical time stamping in conditions such as AF or congestive heart failure ( 40 , 47 , 48 ). Our interpretation of the methodologies is that these refer to chronic as opposed to acute conditions.…”