Polypharmacy and falls in the middle age and elderly population

Ziere, Gijsbertus; Dieleman, Jeanne P.; Hofman, Albert; Pols, H.A.P.; Cammen, Tischa J. M. van der; Stricker, Bruno H. Ch.

doi:10.1111/j.1365-2125.2005.02543.x

Cited by 350 publications

(323 citation statements)

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“…When we additionally adjusted for risk of falls, the magnitude of the association between polypharmacy and bleeding decreased even more, indicating that risk of falls may account for at least some of the relationship between polypharmacy and the risk of bleeding. Overall, although polypharmacy is known to increase the risk of falls in the elderly, mainly as a result of drug-induced sedation and orthostatic hypotension, 11,32 whether an increased falls risk is associated with major bleeding remains controversial. 8,33,34 Finally, a greater number of prescribed drugs may simply reflect patients' higher comorbid burden, an independent predictor of serious bleeding.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

et al. 2014

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BACKGROUND: Polypharmacy, defined as the concomitant use of multiple medications, is very common in the elderly and may trigger drug-drug interactions and increase the risk of falls in patients receiving vitamin K antagonists. OBJECTIVE: To examine whether polypharmacy increases the risk of bleeding in elderly patients who receive vitamin K antagonists for acute venous thromboembolism (VTE). DESIGN: We used a prospective cohort study. PARTICIPANTS: In a multicenter Swiss cohort, we studied 830 patients aged ≥ 65 years with VTE. MAIN MEASURES: We defined polypharmacy as the prescription of more than four different drugs. We assessed the association between polypharmacy and the time to a first major and clinically relevant non-major bleeding, accounting for the competing risk of death. We adjusted for known bleeding risk factors (age, gender, pulmonary embolism, active cancer, arterial hypertension, cardiac disease, cerebrovascular disease, chronic liver and renal disease, diabetes mellitus, history of major bleeding, recent surgery, anemia, thrombocytopenia) and periods of vitamin K antagonist treatment as a time-varying covariate. KEY RESULTS: Overall, 413 (49.8 %) patients had polypharmacy. The mean follow-up duration was 17.8 months. Patients with polypharmacy had a significantly higher incidence of major (9.0 vs. 4.1 events/100 patient-years; incidence rate ratio [IRR] 2.18, 95 % confidence interval [CI] 1.32-3.68) and clinically relevant nonmajor bleeding (14.8 vs. 8.0 events/100 patient-years; IRR 1.85, 95 % CI 1.27-2.71) than patients without polypharmacy. After adjustment, polypharmacy was significantly associated with major (sub-hazard ratio [SHR] 1.83, 95 % CI 1.03-3.25) and clinically relevant nonmajor bleeding (SHR 1.60, 95 % CI 1.06-2.42). CONCLUSIONS: Polypharmacy is associated with an increased risk of both major and clinically relevant nonmajor bleeding in elderly patients receiving vitamin K antagonists for VTE.

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Section: Discussionmentioning

confidence: 99%

Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism

et al. 2014

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“…The number of subjects taking ‡4 medications, which has been implicated in falls in the older population 19 , was not significantly different (p = 0.546) between the fracture group (12 patients) and the control group (15 patients). Specific medications known to contribute to falls in this population did not differ significantly among the groups, including diuretics for treatment of hypertension (12 patients in the fracture group compared with 14 patients in the control group; p = 0.532), hypoglycemic agents for diabetes mellitus (3 patients in the fracture group compared with 1 patient in the control group; p = 0.608), and psychoactive Flow diagram demonstrating the selection of patients for the fracture group.…”

mentioning

confidence: 93%

“…Specific medications known to contribute to falls in this population did not differ significantly among the groups, including diuretics for treatment of hypertension (12 patients in the fracture group compared with 14 patients in the control group; p = 0.532), hypoglycemic agents for diabetes mellitus (3 patients in the fracture group compared with 1 patient in the control group; p = 0.608), and psychoactive Flow diagram demonstrating the selection of patients for the fracture group. 1178 medications (7 patients in the fracture group compared with 6 patients in the control group; p = 0.743) 19,20 . The fracture group and the control group did not differ in their prevalence of potential musculoskeletal confounders (p = 1.00 for both) in the lower extremity (4 patients in the fracture group compared with 3 patients in the control group) or spine (4 patients in the fracture group compared with 3 patients in the control group).…”

mentioning

confidence: 99%

Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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Background: The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. Methods: This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. Results: There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. Conclusions: Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…(yes; no); hospitalization in the previous 6 months (yes; no); and use of polypharmacy 28 (yes; no), obtained from packages and/or physician's prescriptions for medicines, recorded by the brand name and later classified according to the Anatomical Therapeutic Chemical Code (ATC) 29 , defined as concurrent use of four or more medicines.…”

Section: Independent Variablesmentioning

confidence: 99%