Psychotropic drugs and falling accidents among the elderly: a nested case control study in the whole population of Scania, Sweden

Modén, Birgit; Merlo, Juan; Ohlsson, Henrik; Rosvall, Maria

doi:10.1136/jech.2009.098947

Cited by 47 publications

(38 citation statements)

References 40 publications

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“…13 In addition to previous opioid use, being a female, being older, having a history of alcoholism and using antidepressants or antipsychotics drugs were significantly associated with fall-related injuries, which is in accordance with previous studies. 13,15,[25][26][27] We found that more women than men had filled an opioid prescription before the fall-related injury. Another study found the same result but for all types of injury mechanisms.…”

Section: Discussionsupporting

confidence: 81%

“…Specifically, opioid use was more likely to induce a fall within the next week (odds ratio [OR] = 6.07 for men and 5.16 for women). 13 In another study in a level-1 trauma centre with patients of all ages, falls were more prevalent among patients who had used opioids in the month preceding the trauma compared with patients who had not (32.8% v. 22.0%). 10 Furthermore, Söderberg and colleagues found that taking opioids increases the likelihood of an imminent fall-related injury.…”

mentioning

confidence: 99%

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Recent opioid use and fall-related injury among older patients with trauma

Daoust

Paquet

Moore

et al. 2018

CMAJ

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T he rate of opioid prescription for pain treatment has been increasing rapidly in North America in the past 20 years.1,2 For example, between 2001 and 2010, the percentage of patients receiving an opioid prescription during an emergency department visit increased from 20.8% to 31%, a relative increase of 49%.1 Furthermore, the frequency of opioid prescription increases with age. Opioids are sometimes necessary to treat acute pain, but they can cause adverse effects, especially in the older population.4-6 It has been found that drugs that affect the central nervous system (e.g., drugs that cause sedation and dizziness) can increase the risk of falling.7 Falls are frequent among people aged 65 years and older (28%-35% fall each year) 8 and constitute a leading cause of injuries, hospital admissions and deaths among older people. 9Several studies have established an association between opioid use and risk of falls or fractures in the older population.10-17 In a nested case-control study, Moden and colleagues found that using psychotropic drugs increased the risk of falls in older people. Specifically, opioid use was more likely to induce a fall within the next week (odds ratio [OR] = 6.07 for men and 5.16 for women).13 In another study in a level-1 trauma centre with patients of all ages, falls were more prevalent among patients who had used opioids in the month preceding the trauma compared with patients who had not (32.8% v. 22.0%).10 Furthermore, Söderberg and colleagues found that taking opioids increases the likelihood of an imminent fall-related injury.12 For example, having a prescription of opioids filled 1 week before the fall is associated with an OR of 5.14 of falling compared with an OR of 1.23 when the prescription is filled within 4 weeks of the fall. However, other studies did not find a significant association between opioid use and falls, [18][19][20] and none examined this in severely injured older people who are at higher risk of death.The objectives of the study were to examine the association between recent opioid use and the risk, as well as the clinical outcomes, of fall-related injury in a large trauma population of older adults. We hypothesized that fall-related injuries will be more likely to occur with recent opioid use than injuries that occur from other mechanisms. Evidence for an association between opioid use and risk of falls or fractures in older adults is inconsistent. We examine the association between recent opioid use and the risk, as well as the clinical outcomes, of fall-related injuries in a large trauma population of older adults.

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Recent opioid use and fall-related injury among older patients with trauma

Daoust

Paquet

Moore

et al. 2018

CMAJ

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“…The DDDs are frequently used as a proxy for prescribed doses when measuring the legend durations of psychotropic drug exposures (Bak et al ., ; Tiihonen et al ., ; Modén et al ., ). However, the findings of our study indicate that older people tend to be prescribed psychotropic drugs with lower doses than those of the DDDs.…”

Section: Discussionmentioning

confidence: 97%

Measuring psychotropic drug exposures in register‐based studies – validity of a dosage assumption of one unit per day in older Finns

Rikala

Hartikainen

Saastamoinen

et al. 2013

Int J Methods Psych Res

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Pharmacoepidemiological studies provide valuable information on the relationships between psychotropic drug use and adverse outcomes in older people. To minimize the influence of misclassification bias in pharmacoepidemiological studies, more emphasis should be given to methodological aspects of exposure assessment. This study evaluated the validity of a dosage assumption of one unit per day for measuring legend duration of psychotropic drug exposures among older people. Using data from the Finnish Prescription Register, the study analysed 62,320 psychotropic drug prescriptions dispensed for people aged ≥ 75 years (n = 52,729) in September 2009. The proportions of prescriptions in which the prescribed dose deviated from one unit per day were assessed for categories and subcategories of psychotropic drugs. The prescription was considered misclassified (a) if the prescribed drug was intended for "as needed" use, (b) if the prescription included a dose range, or (c) if the prescribed dose was below or above one unit per day. Among antidepressants, less than every fourth (23.7%) prescription was misclassified. The proportions of misclassification varied substantially across subcategories, being 13.1% for selective serotonin reuptake inhibitors (SSRIs), 25.3% for other antidepressants and 53.8% for tricyclic antidepressants. Of the benzodiazepine and antipsychotic prescriptions, 79.9% and 57.6%, respectively, were misclassified. In conclusion, the dosage assumption of one unit per day is valid for measuring the legend duration of SSRI and other antidepressant exposures among older people. Among other psychotropic drugs, the dosage assumption is likely to lead to severe exposure misclassification.

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“…Dada la dimensión de la muestra, no fue posible demostrar ninguna asociación entre las variables en estudio, en contra de lo que se encontró descrito en la literatura. Aun así, los factores estudiados constituyeron un riesgo elevado de que se produzcan caídas en los pacientes [24][25][26].…”

Section: Benzodiazepinasunclassified

Psicofármacos y riesgo de caídas en ancianos: resultados preliminares del estudio piloto caso-control anidado en una residencia de ancianos portuguesa

Palanca¹,

Aguiar²,

Costa³

2017

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Originales RESUMENIntroducción: Las caídas son frecuentes entre los ancianos, los cuales toman muchos medicamentos y algunos de ellos, como los psicofármacos, pueden aumentar el riesgo de caídas.Objetivos: Investigar la relación entre el uso de psicofármacos y la aparición de caídas en pacientes ancianos institucionalizados e identificar los fármacos más utilizados en estos pacientes. Además, se estudió el riesgo asociado al número de psicofármacos que el paciente estaba tomando y el riesgo de caídas que provocaron.Material y métodos: Se realizó un estudio caso-control anidado a partir de una cohorte de pacientes polimedicados internados en una residencia. Los casos fueron pacientes con caídas, entre agosto de 2014 y diciembre de 2015, y los controles aquellos que no cayeron. La exposición a psicofármacos fue investigada en los 2 grupos retrospectivamente. La información fue recogida de la base de datos de la residencia por personal sanitario. El análisis se centró en las OR de caídas por grupo terapéutico, usando un IC de 95%.Resultados: Se analizó una muestra de 22 pacientes, 9 casos y 13 controles: mayoría mujeres, y edad media 82,3 años (DE=6,5). Cada residente tomó una media de 11 medicamentos (DE=4,6). El grupo farmacoterapéutico y el fármaco más utilizados fueron antipsicóticos y quetiapina (59,1%, n=13; 45,5%, n=10, respectivamente). Los OR calculados demuestran no haber ninguna asociación estadísticamente significativa entre los subgrupos terapéuticos y/o fármacos con un elevado riesgo de caídas (p. ej. quetiapina: OR=4.5; IC=0,730-27,739; antipsicóticos atípicos: OR=3,2; IC=0,540-18,980).Conclusión: Como los resultados fueron obtenidos de una muestra limitada, no se demostraron relaciones significativas, aunque sí una clara relación entre el uso de psicofármacos y el riesgo de caídas, identificando aquellos grupos farmacoterapéuticos más influyentes en caídas. Psychopharmaceuticals and the risk of falls among elderly people: preliminary results of the nested case-control pilot study in a Portuguese care home ABSTRACTIntroduction: Falls are frequent in the elderly, because they take medication that may increase the risk of falls, including psychotropic drugs.Aims: To explore the relationship between the use of psychotropic drugs and the occurrence of falls in institutionalized patients, and to identify the most used drugs in these patients. In addition, it was studied the risk associated with the psychotropic drugs and the risk of falls that they caused. PALABRAS CLAVEAncianos, psicofármacos, caídas, farmacoepidemiología, seguimiento farmacoterapéutico, seguridad terapéutica, residencia de ancianos Financiación: Ninguna. Contribución a la autoría: MGP contribuyó al desarrollo del estudio, el análisis de los resultados, a la redacción del manuscrito y a la revisión del manuscrito final. JPA al análisis de los resultados, el tratamiento estadístico, a la redacción del manuscrito y a la revisión del manuscrito final. AMC al diseño y desarrollo del estudio, al análisis de los resultados y a la revisión del ...

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Psychotropic drugs and falling accidents among the elderly: a nested case control study in the whole population of Scania, Sweden

Cited by 47 publications

References 40 publications

Recent opioid use and fall-related injury among older patients with trauma

Recent opioid use and fall-related injury among older patients with trauma

Measuring psychotropic drug exposures in register‐based studies – validity of a dosage assumption of one unit per day in older Finns

Psicofármacos y riesgo de caídas en ancianos: resultados preliminares del estudio piloto caso-control anidado en una residencia de ancianos portuguesa

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