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Drugs & Aging

, Volume 35, Issue 1, pp 73–81 | Cite as

Drug Burden and its Association with Falls Among Older Adults in New Zealand: A National Population Cross-Sectional Study

  • Hamish A. Jamieson
  • Prasad S. Nishtala
  • Richard Scrase
  • Joanne M. Deely
  • Rebecca Abey-Nesbit
  • Martin J. Connolly
  • Sarah N. Hilmer
  • Darrell R. Abernethy
  • Philip J. Schluter
Original Research Article

Abstract

Background

Adverse outcomes associated with advanced diseases are often exacerbated by polypharmacy.

Objectives

The current study investigated an association between exposure to anticholinergic and sedative medicines and falls in community-dwelling older people, after controlling for potential confounders.

Methods

We conducted a retrospective cross-sectional study of a continuously recruited national cohort of community-dwelling New Zealanders aged 65 years and over. Participants had an International Resident Assessment Instrument–Home Care (interRAI-HC) assessment between 1 September 2012 and 31 January 2016. InterRAI-HC is a comprehensive, multi-domain, standardised assessment. This study captured 18 variables, including fall frequency, from the interRAI. These data were deterministically matched with the Drug Burden Index (DBI) for each participant, derived from an anonymised national dispensed pharmaceuticals database. DBI groupings were statistically ascertained, and ordinal regression models employed.

Results

Overall, there were 71,856 participants, with a mean age of 82.7 years (range 65–106); 43,802 (61.0%) were female, and 63,578 (88.5%) were New Zealand European. In unadjusted and adjusted analyses, DBI groupings were related to falls (p < 0.001). A DBI score > 3 was associated with a 41% increase in falls compared with a DBI score of 0 (p < 0.001). There was a ‘dose-response’ relationship between DBI levels and falls risk.

Conclusions

DBI was found to be independently and positively associated with a greater risk of falls in this cohort after adjustment for 18 known confounders. We suggest that the DBI could be a valuable tool for clinicians to use alongside electronic prescribing to help reduce falls in older people.

Notes

Compliance and Ethical Standards

Funding

This work was supported by funding from the New Zealand Ageing Well National Science Challenge (IS111882.08.P.PM) and the Canterbury Healthcare of the Elderly Education Trust.

Conflict of interest

Hamish Jamieson, Prasad Nishtala, Richard Scrase, Joanne Deely, Rebecca Abey-Nisbet, Martin Connolly, Sarah Hilmer, Darrell Abernethy and Philip Schluter declare that they have no conflicts of interest relevant to the content of this article.

Supplementary material

40266_2017_511_MOESM1_ESM.docx (59 kb)
Supplementary material 1 (DOCX 58 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Hamish A. Jamieson
    • 1
  • Prasad S. Nishtala
    • 2
  • Richard Scrase
    • 3
  • Joanne M. Deely
    • 4
  • Rebecca Abey-Nesbit
    • 5
  • Martin J. Connolly
    • 6
    • 7
  • Sarah N. Hilmer
    • 8
  • Darrell R. Abernethy
    • 9
  • Philip J. Schluter
    • 10
    • 11
  1. 1.Department of MedicineUniversity of Otago, Christchurch: Geriatrician, Burwood HospitalChristchurchNew Zealand
  2. 2.School of PharmacyUniversity of OtagoDunedinNew Zealand
  3. 3.Canterbury District Health BoardChristchurchNew Zealand
  4. 4.Department of MedicineUniversity of OtagoChristchurchNew Zealand
  5. 5.University of OtagoChristchurchNew Zealand
  6. 6.University of AucklandAucklandNew Zealand
  7. 7.Waitemata District Health BoardAucklandNew Zealand
  8. 8.The University of SydneySydneyAustralia
  9. 9.Office of Clinical Pharmacology at the Food and Drug AdministrationSilver SpringUSA
  10. 10.University of Canterbury–Te Whare Wānanga o WaitahaChristchurchNew Zealand
  11. 11.School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneAustralia

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