Fall-risk-increasing adverse reactions—is there value in easily accessible drug information? A case-control study
The individual fall risk of a patient is often multifactorial. Polymedication contributes to an additional risk of fall-risk-increasing adverse reactions (FRIARs). Previous studies have not sufficiently investigated the complexity facing prescribers when balancing the therapeutic benefits of individual drugs against their potential fall risk.
An expert panel identified drugs with FRIARs based on the Summary of Product Characteristics (SmPC). These FRIARs and other parameters (such as the total number of drugs, dosage, dose adjustments, and drug changes) were then analyzed for their impact on falls in a case-control study using logistic regression.
During a 1-year period, 112 (1%) of 11,481 hospital patients experienced at least one fall event. Complete data was available for evaluation from 87 of them (case group). We matched these patients to another 87 patients who had no fall events (control group). FRIAR drugs were more frequently prescribed in the case group (4.26 (Q25–Q75, 3.75–4.78) per patient; p = 0.033) than in the control group (3.48 (2.97–3.99)). Drugs with FRIARs (β = 0.137; p = 0.035) and the total number of FRIARs (β = 0.033; p = 0.031) increased the fall risk. The total number of drugs, dosage, dose adjustments, and drug changes showed no influence.
FRIARs were associated with a higher number of falls. To consider FRIARs offers a chance to address the complexity of the individual medication. This data can support future computerized physician order entries with clinical decision support.
KeywordsPatient safety Inpatients Drug therapy Fall-risk-increasing drugs Adverse reactions Drug label
We thank all physicians and nurses in the participating departments for their helpful support in this study and Professor Benjamin R. Auer, Ph.D., for statistical guidance and Katharine Worthington, Jena M. Gaines, and Professor Astrid Bertsche, M.D., for language editing.
Susanne Schiek contributed to the study conception, analyzed and interpreted the data, and wrote the manuscript.
Katja Hildebrandt contributed to the study conception, collected and analyzed the data, and revised the manuscript.
Olaf Zube initiated the study, contributed to the study conception, and revised the manuscript.
Thilo Bertsche contributed to the study conception, interpreted the data, and wrote the manuscript.
This study was financed by the institutions as mentioned above and was performed without third party funding.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (retrospective case-control study), formal consent is not required.
- 4.Blain H, Masud T, Dargent-Molina P, Martin FC, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis JA, Reginster JY, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer KE, Vellas B, Maggi S, Strandberg T, EUGMS Falls and Fracture Interest Group, IAGG-ER, EUMS, FFN, ESCEO, IOF (2016) A comprehensive fracture prevention strategy in older adults: the European Union Geriatric Medicine Society (EUGMS) statement. Aging Clin Exp Res 28(4):797–803. https://doi.org/10.1007/s40520-016-0588-4 CrossRefGoogle Scholar
- 8.Iliffe S, Kharicha K, Harari D, Swift C, Gillmann G, Stuck AE (2007) Health risk appraisal in older people 2: the implications for clinicians and commissioners of social isolation risk in older people. Br J Gen Pract 57(537):277–282Google Scholar
- 27.Holt S, Schmiedl S, Thürmann PA (2011) Priscus list – potentially inadequate medication for the elderly. IOP Publishing PhysicsWeb. http://priscus.net/download/PRISCUS-Liste_PRISCUS-TP3_2011.pdf. Accessed 20 June 2018
- 31.Campbell N, Boustani M, Limbil T, Ott C, Fox C, Maidment I, Schubert CC, Munger S, Fick D, Miller D, Gulati R (2009) The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging 4:225–233Google Scholar
- 34.Haefeli WE (2018) Dosing – dose adjustment of renal eliminated drugs in patients with renal insufficiency. IOP Publishing PhysicsWeb. http://dosing.de Accessed 20 June 2018
- 36.Bennett A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, Fastbom J, Hilmer S (2014) Prevalence and impact of fall-risk-increasing drugs, polypharmacy, and drug-drug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. Drugs Aging 31(3):225–232. https://doi.org/10.1007/s40266-013-0151-3 CrossRefGoogle Scholar
- 44.Sterke CS, Ziere G, van Beeck EF, Looman CW, van der Cammen TJ (2012) Dose-response relationship between selective serotonin re-uptake inhibitors and injurious falls: a study in nursing home residents with dementia. Br J Clin Pharmacol 73(5):812–820. https://doi.org/10.1111/j.1365-2125.2011.04124.x CrossRefGoogle Scholar
- 45.Herr M, Sirven N, Grondin H, Pichetti S, Sermet C (2017) Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population. Eur J Clin Pharmacol 73(9):1165–1172. https://doi.org/10.1007/s00228-017-2276-5 CrossRefGoogle Scholar