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International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 243–251 | Cite as

Exploring the relationship between fall risk-increasing drugs and fall-related fractures

  • Sabrina De WinterEmail author
  • Sarah Vanwynsberghe
  • Veerle Foulon
  • Eddy Dejaeger
  • Johan Flamaing
  • An Sermon
  • Lorenz Van der Linden
  • Isabel Spriet
Research Article

Abstract

Background

Hospital admissions due to fall-related fractures are a major problem in the aging population. Several risk factors have been identified, including drug use. Most studies often retrieved prescription-only drugs from national databases. These are associated with some limitations as they do not always reliably reproduce the complete patient’s active drug list.

Objective

To evaluate the association between the number of FRIDs intake identified by a standardised medication reconciliation process and a fall-related fracture leading to a hospital admission in older adults.

Setting

The first cohort has been recruited from one traumatology ward of a tertiary teaching hospital in Belgium and the second cohort has been recruited from 11 community pharmacies in Belgium.

Method

A prospective study with two individually matched cohorts was performed. Adult patients (≥75 years) admitted with an injury due to a fall were included in the first cohort (faller group). The second cohort consisted of patients who did not suffer from a fall within the last 6 months (non-faller group). Matching was performed for age, gender, place of residence and use of a walking aid. In both groups, clinical pharmacists and undergraduate pharmacy students obtained the medication history, using a standardised approach. A list of drugs considered to increase the risk of falling was created. It included cardiovascular drugs and drugs acting on the nervous system. A linear mixed model was used to compare the number of fall risk-increasing drugs between fallers and non-fallers.

Main outcome measure

The number of fall risk-increasing drugs in a faller versus a non-faller group.

Results

Sixty-one patients were matched with 121 non-fallers. Patients received on average 3.1 ± 2.1 and 3.2 ± 1.8 fall risk-increasing drugs in the faller and in the non-faller group, respectively. The mean number of fall risk-increasing drugs was comparable in both groups (p = 0.844), even after adjusting for alcohol consumption, fear of falling, vision and foot problems (p = 0.721).

Conclusion

In a sample of hospitalised patients admitted for a fall-related injury, no significant difference in the number of fall risk-increasing drugs versus that of an outpatient group of non-fallers was found.

Keywords

Belgium Falls Fall risk-increasing drugs Fractures Hospitalisation Older adults 

Notes

Acknowledgments

We would like to express our special thanks to Prof. Dr. Apr. Gert Laekeman, Clinical Pharmacology and Pharmacotherapy, Dpt Pharmaceutical and Pharmacological Sciences, KU Leuven, for his contribution to this study, to keep this project on track in the community pharmacies and for carefully reading this manuscript. We would like to thank all the collaborating undergraduate pharmacy students and the community pharmacies. Finally, we also want to thank Annouschka Laenen, Leuven Biostatistics and Statistical Bioinformatics Centre, Dpt of Public Health and Primary Care, KU Leuven for the statistical assistance.

Funding

None.

Conflicts of interest

None.

Supplementary material

11096_2015_230_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)

References

  1. 1.
    Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006;90:807–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Pohl P, Nordin E, Lundquist A, Bergström U, Lundin-Olsson L. Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years—a prospective long-term follow-up study. BMC Geriatr. 2014;14:120. doi: 10.1186/1471-2318-14-120.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Karlsson MK, Vonschewelov T, Karlsson C, Cöster M, Rosengen BE. Prevention of falls in the elderly: a review. Scand J Public Health. 2013;41:442–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging. 2012;29:359–76.CrossRefPubMedGoogle Scholar
  5. 5.
    Campbell AJ. Drug treatment as a cause of falls in old age. A review of the offending agents. Drugs Aging. 1991;1:289–302.CrossRefPubMedGoogle Scholar
  6. 6.
    Bulat T, Castle SC, Rutledge M, Quigley P. Clinical practice algorithms: medication management to reduce fall risk in the elderly—part 3, benzodiazepines, cardiovascular agents, and antidepressants. J Am Acad Nurse Pract. 2008;20:55–62.CrossRefPubMedGoogle Scholar
  7. 7.
    Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174:890–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146. doi: 10.1002/14651858.CD007146.pub3.PubMedGoogle Scholar
  9. 9.
    Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2012;12:CD005465. doi: 10.1002/14651858.CD005465.pub3.PubMedGoogle Scholar
  10. 10.
    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47:30–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47:40–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169:1952–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Gribbin J, Hubbard R, Gladman JR, Smith C, Lewis S. Risk of falls associated with antihypertensive medication: population-based case-control study. Age Ageing. 2010;39:592–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Gribbin J, Hubbard R, Gladman J, Smith C, Lewis S. Risk of falls associated with antihypertensive medication: self-controlled case series. Pharmacoepidemiol Drug Saf. 2011;20:879–84.CrossRefPubMedGoogle Scholar
  15. 15.
    Aung K, Htay T. Thiazide diuretics and the risk of hip fracture. Cochrane Database Syst Rev. 2011;10:CD005185. doi: 10.1002/14651858.CD005185.pub2.PubMedGoogle Scholar
  16. 16.
    Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172:1739–44.CrossRefPubMedGoogle Scholar
  17. 17.
    Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of falls on initiation of antihypertensive drugs in the elderly. Osteoporos Int. 2013;24:2649–57.CrossRefPubMedGoogle Scholar
  18. 18.
    Lapane KL, Yang S, Brown MJ, Jawahar R, Pagliasotti C, Rajpathak S. Sulfonylureas and risk of falls and fractures: a systematic review. Drugs Aging. 2013;30:527–47.CrossRefPubMedGoogle Scholar
  19. 19.
    Bloch F, Thibaud M, Tournoux-Facon C, Brèque C, Rigaud AS, Dugué B, et al. Estimation of the risk factors for falls in the elderly: can meta-analysis provide a valid answer? Geriatr Gerontol Int. 2013;13:250–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Tinetti ME, Han L, Lee DS, McAvay GJ, Peduzzi P, Gross CP, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174:588–95.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Milos V, Bondesson A, Magnusson M, Jakobsson U, Westerlund T, Midlöv P. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatr. 2014;14:40. doi: 10.1186/1471-2318-14-40.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Wiens M, Etminan M, Gill SS, Takkouche B. Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies. J Intern Med. 2006;260:350–62.CrossRefPubMedGoogle Scholar
  23. 23.
    Rejnmark L, Vestergaard P, Mosekilde L. Treatment with beta-blockers, ACE inhibitors, and calcium-channel blockers is associated with a reduced fracture risk: a nationwide case-control study. J Hypertens. 2006;24:581–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005;173:510–5.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    De Winter S, Spriet I, Indevuyst C, Vanbrabant P, Desruelles D, Sabbe M, et al. Pharmacist- versus physician-acquired medication history: a prospective study at the emergency department. Qual Saf Health Care. 2010;19:371–5.PubMedGoogle Scholar
  26. 26.
    Etchells E, Koo M, Daneman N, McDonald A, Baker M, Matlow A, et al. Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review. BMJ Qual Saf. 2012;21:448–56.CrossRefPubMedGoogle Scholar
  27. 27.
    van den Bemt PM, van der Schrieck-de Loos EM, van der Linden C, Theeuwes AM, Pol AG, Dutch CBO WHO High 5 s Study Group. Effect of medication reconciliation on unintentional medication discrepancies in acute hospital admissions of elderly adults: a multicenter study. J Am Geriatr Soc. 2013;61:1262–8.CrossRefPubMedGoogle Scholar
  28. 28.
    World Health Organisation (WHO) (2013) Guidelines for ATC classification and DDD assignment (document on the internet). Oslo: WHO collaborating Centre for Drug Statistics Methodology. http://www.whocc.no/filearchive/publications/1_2013guidelines.pdf.
  29. 29.
    Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.CrossRefPubMedGoogle Scholar
  30. 30.
    Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK, et al. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;149:404–15.CrossRefPubMedGoogle Scholar
  31. 31.
    (2011) Expertisecentrum Val-en fractuurpreventie Vlaanderen. Draaiboek zorgpad valpreventie (document on the internet). Expertisecentrum Val-en fractuurpreventie Vlaanderen. http://www.valpreventie.be/Portals/Valpreventie/Documenten/thuis/EVV_Draaiboek_zorgpad_valpreventie.pdf.
  32. 32.
    Lindquist LA, Gleason KM, McDaniel MR, Doeksen A, Liss D. Teaching medication reconciliation through simulation: a patient safety initiative for second year medical students. J Gen Intern Med. 2008;23:998–1001.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    French DD, Campbell R, Spehar A, Cunningham F, Bulat T, Luther SL. Drugs and falls in community-dwelling older people: a national veterans study. Clin Ther. 2006;28:619–30.CrossRefPubMedGoogle Scholar
  34. 34.
    Lamis RL, Kramer JS, Hale LS, Zackula RE, Berg GM. Fall risk associated with inpatient medications. Am J Health Syst Pharm. 2012;69:1888–94.CrossRefPubMedGoogle Scholar
  35. 35.
    Kelsey J, Berry SD, Procter-Gray E, Quach L, Nguyen US, Li W, et al. Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston Study. J Am Geriatr Soc. 2010;58:2135–41.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Giladi AM, Shauver MJ, Ho A, Zhong L, Kim HM, Chung KC. Variation in the incidence of distal radius fractures in the U.S. elderly as related to slippery weather conditions. Plast Reconstr Surg. 2014;133:321–32.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Echt MA, Samelson EJ, Hannan MT, Dufour AB, Berry SD. Psychotropic drug initiation or increased dosage and the acute risk of falls: a prospective cohort study of nursing home residents. BMC Geriatr. 2013;13:19. doi: 10.1186/1471-2318-13-9.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Berry SD, Lee Y, Cai S, Dore DD. Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents. JAMA Intern Med. 2013;173:754–61.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2016

Authors and Affiliations

  • Sabrina De Winter
    • 1
    Email author
  • Sarah Vanwynsberghe
    • 1
  • Veerle Foulon
    • 2
  • Eddy Dejaeger
    • 3
  • Johan Flamaing
    • 3
  • An Sermon
    • 4
  • Lorenz Van der Linden
    • 1
  • Isabel Spriet
    • 1
  1. 1.Clinical Pharmacology and PharmacotherapyUniversity Hospitals LeuvenLouvainBelgium
  2. 2.Clinical Pharmacology and PharmacotherapyCatholic University LeuvenLouvainBelgium
  3. 3.Gerontology and GeriatricsUniversity Hospitals LeuvenLouvainBelgium
  4. 4.TraumatologyUniversity Hospitals LeuvenLouvainBelgium

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