Journal of General Internal Medicine

, Volume 25, Issue 2, pp 141–146 | Cite as

The Association Between the Number of Prescription Medications and Incident Falls in a Multi-ethnic Population of Adult Type-2 Diabetes Patients: The Diabetes and Aging Study

  • Elbert S. Huang
  • Andrew J. Karter
  • Kirstie K. Danielson
  • E. Margaret Warton
  • Ameena T. Ahmed
Original Article

Abstract

Background

Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes.

Objective

We evaluated the association between number of prescription medications and incident falls in a multi-ethnic population of type-2 diabetes patients in order to establish an evidence-based medication threshold for fall risk in diabetes.

Design

Baseline survey (1994-1997) with 5 years of longitudinal follow-up.

Participants

Eligible subjects (N = 46,946) had type-2 diabetes, were ≥18 years old, and enrolled in the Kaiser Permanente Northern California Diabetes Registry.

Measurements and main results

We identified clinically recognized incident falls based on diagnostic codes (ICD-9 codes: E880-E888). Relative to regimens of 0-1 medications, regimens including 4 or more prescription medications were significantly associated with an increased risk of falls [4-5 medications adjusted HR 1.22 (1.04, 1.43), 6-7 medications 1.33 (1.12, 1.58), >7 medications 1.59 (1.34, 1.89)]. None of the individual glucose-lowering medications was found to be significantly associated with a higher risk of falls in predictive models.

Conclusions

The prescription of four or more medications was associated with an increased risk of falls among adult diabetes patients, while no specific glucose-lowering agent was linked to increased risk. Baseline risk of falls and number of baseline medications are additional factors to consider when deciding whether to intensify diabetes treatments.

KEY WORDS

falls polypharmacy insulin geriatrics 

References

  1. 1.
    U.K. Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53.CrossRefGoogle Scholar
  2. 2.
    Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383–93.CrossRefPubMedGoogle Scholar
  3. 3.
    Huang ES, Basu A, Finch M, Frytak J, Manning W. The complexity of medication regimens and test ordering for patients with diabetes from 1995 to 2003. Curr Med Res Opin. 2007;23(6):1423–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Saaddine JB, Cadwell B, Gregg EW, et al. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Ann Intern Med. 2006;144(7):465–74.PubMedGoogle Scholar
  5. 5.
    Brown AF, Mangione CM, Saliba D, Sarkisian CA, California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidlines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003;51(5 Suppl Guidelines):S265–S280.PubMedGoogle Scholar
  6. 6.
    American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2004;27(Supplement 1):S15–S35.Google Scholar
  7. 7.
    Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract. 2005;17(4):123–32.CrossRefPubMedGoogle Scholar
  8. 8.
    Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003;348(1):42–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Cooper JW. Probable adverse drug reactions in a rural geriatric nursing home population: a 4-year study. J Am Geriatr Soc. 1996;44(2):194–7.PubMedGoogle Scholar
  10. 10.
    Gray SL, Sager M, Lestico MR, Jalaluddin M. Adverse drug events in hospitalized elderly. J Gerontol, Ser A Biol Sci Med Sci. 1998;53(1):M59–M63.Google Scholar
  11. 11.
    Gray SL, Mahoney JE, Blough DK. Adverse drug events in elderly patients receiving home health services following hospital discharge. Ann Pharmacother. 1999;33(11):1147–53.CrossRefPubMedGoogle Scholar
  12. 12.
    Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161(13):1629–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Agostini JV, Han L, Tinetti ME. The relationship between number of medications and weight loss or impaired balance in older adults. J Am Geriatr Soc. 2004;52(10):1719–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet. 1999;353(9147):93–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Wagner EH, LaCroix AZ, Grothaus L, et al. Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health. 1994;84(11):1800–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331(13):821–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Schwartz AV, Vittinghoff E, Sellmeyer DE, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31(3):391–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Schwartz AV, Hillier TA, Sellmeyer DE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002;25(10):1749–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Selby JV, Ray GT, Zhang D, Colby CJ. Excess costs of medical care for patients with diabetes in a managed care population. Diabetes Care. 1997;20(9):1396–402.CrossRefPubMedGoogle Scholar
  20. 20.
    Ferrara A, Karter AJ, Ackerson LM, Liu JY, Selby JV. Hormone replacement therapy is associated with better glycemic control in women with type 2 diabetes: The Northern California Kaiser Permanente Diabetes Registry. Diabetes Care. 2001;24(7):1144–50.CrossRefPubMedGoogle Scholar
  21. 21.
    Karter AJ, Ackerson LM, Darbinian JA, et al. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med. 2001;111(1):1–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Gual A, Segura L, Contel M, Heather N, Colom J. Audit-3 and audit-4: effectiveness of two short forms of the alcohol use disorders identification test. Alcohol Alcohol. 2002;37(6):591–6.PubMedGoogle Scholar
  23. 23.
    Karter AJ, Ferrara A, Darbinian JA, Ackerson LM, Selby JV. Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care. 2000;23(4):477–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.CrossRefPubMedGoogle Scholar
  25. 25.
    Bates DW, Miller EB, Cullen DJ, et al. Patient risk factors for adverse drug events in hospitalized patients. ADE Prevention Study Group. Arch Intern Med. 1999;159(21):2553–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178–208.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Elbert S. Huang
    • 1
    • 4
  • Andrew J. Karter
    • 2
  • Kirstie K. Danielson
    • 3
  • E. Margaret Warton
    • 2
  • Ameena T. Ahmed
    • 2
  1. 1.Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Kaiser Permanente Division of ResearchOaklandUSA
  3. 3.Institute for Endocrine Discovery and Clinical CareUniversity of ChicagoChicagoUSA
  4. 4.ChicagoUSA

Personalised recommendations