Association Between Prescribing of Cardiovascular and Psychotropic Medications and Hospital Admission for Falls or Fractures
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Background and Objective
Falls are a major cause of morbidity and mortality in the elderly. This study examined the frequency of hospital admission for falls or fractures, and the association with a recent change in the use of cardiovascular and psychotropic medications.
We conducted a retrospective case-cohort study of 39,813 patients aged >65 years from 40 Scottish general practices. Data on current prescriptions, dates of drug changes (defined as increases in dose or starting new drugs), diagnoses and clinical measurements were extracted from primary care electronic records, linked to national hospital admissions data. Multivariable logistic regression was used to model the association of change in prescribing of cardiovascular or psychotropic medication with admission to hospital for falls or fractures in the following 60 days.
A total of 838 patients (2.1 %) were admitted in the 1-year study period. Following adjustment for factors including age, sex, socioeconomic deprivation, co-morbidity and current prescribing, changes in both cardiovascular and psychotropic medications were associated with subsequent admission for falls or fractures (odds ratio [OR] 1.54 [95 % confidence interval (CI) 1.17–2.03] and 1.68 [95 % CI 1.28–2.22], respectively). There was no evidence for a difference in the effect of change in medication for different cardiovascular drug types (p = 0.86), but there was evidence (p = 0.003) for variation in the association between change in different psychotropic medications and admission; the strongest associations were observed for changes in selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 1.99 [95 % CI 1.29–3.08]), non-SSRI/tricyclic antidepressants (OR 4.39 [95 % CI 2.21–8.71]) and combination psychotropic medication (OR 3.05 [95 % CI 1.66–5.63]).
Recent changes in psychotropic and cardiovascular medications are associated with a substantial increase in risk of hospital admission for falls and fractures. Caution should thus be taken when instigating prescribing changes in relation to these medicines, particularly in individuals already considered to be at high risk, such as those with multiple co-morbidities and the oldest old.
- Gribbin J, Hubbard R, Smith C, et al. Incidence and mortality of falls amongst older people in primary care in the United Kingdom. QJM. 2009;102:477–83. CrossRef
- Shumway-Cook A, Ciol MA, Hoffman J, et al. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther. 2009;89:324–32. CrossRef
- Scuffham P, Chaplin S, Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health. 2003;57:740–4. CrossRef
- Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age Ageing. 1999;28:121–5. CrossRef
- Hartholt KA, Van Beeck EF, Polinder S, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma. 2011;71:748–53. CrossRef
- O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993;137:342–54.
- Hartikainen S, Lonnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007;62:1172–81. CrossRef
- Morgan SG. Prescription drug expenditures and population demographics. Health Serv Res. 2006;41:411–28. CrossRef
- Ohayon MM, Caulet M, Priest RG, Guilleminault C. Psychotropic medication consumption patterns in the UK general population. J Clin Epidemiol. 1998;51:273–83. CrossRef
- Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67:1175–88. CrossRef
- Joint Formulary Committee. British National Formulary (BNF) 62. London: BMJ Group and Pharmaceutical Press; 2011.
- ISD Scotland. Practice Team Information (PTI) statistics. http://www.isdscotland.org/Health-Topics/General-Practice/PTI-Statistics/. Accessed 26 July 2012.
- ISD Scotland. NHS hospital data quality—towards better data from Scottish hospitals. An assessment of SMR01 and associated data 2004–2006. Edinburgh: NHS National Services Scotland; 2007.
- Royston P. Multiple imputation of missing values. Stata J. 2007;7:445–64.
- Kerse N, Flicker L, Pfaff JJ, et al. Falls, depression and antidepressants in later life: a large primary care appraisal. PLoS One. 2008; 3:e2423.
- Lonergan E, Luxenberg J, Areosa SA. Benzodiazepines for delirium. Cochrane Database Syst Rev. 2009;(4):CD006379.
- Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169:1952–60. CrossRef
- Gribbin J, Hubbard R, Gladman J, et al. Serotonin-norepinephrine reuptake inhibitor antidepressants and the risk of falls in older people: case-control and case-series analysis of a large UK primary care database. Drugs Aging. 2011;28:895–902. CrossRef
- Berry SD, Zhang Y, Lipsitz LA, et al. Antidepressant prescriptions: an acute window for falls in the nursing home. J Gerontol A Biol Sci Med Sci. 2011;66:1124–30. CrossRef
- Association Between Prescribing of Cardiovascular and Psychotropic Medications and Hospital Admission for Falls or Fractures
Drugs & Aging
Volume 30, Issue 4 , pp 247-254
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- 1. Primary Care Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
- 2. eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
- 3. Clinical Pharmacology Unit, The University of Edinburgh, Edinburgh, UK