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Different Risk-Increasing Drugs in Recurrent versus Single Fallers: Are Recurrent Fallers a Distinct Population?

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Abstract

Background

Polypharmacy, and specifically the use of multiple fall-risk-increasing drugs (FRID), have been associated with increased risk of falling in older age. However, it is not yet clear whether the known set of FRIDs can be extrapolated to recurrent fallers, since they form a distinct group of more vulnerable older persons with different characteristics.

Objectives

We aim to investigate which classes of medications are associated with recurrent falls in elderly patients visiting the Emergency Department (ED) after a fall.

Methods

This study had a cross-sectional design and was conducted in the ED of an academic medical center. Patients who sustained a fall, 65 years or older, and who visited the ED between 2004 and 2010 were invited to fill in a validated fall questionnaire designed to assess patient and fall characteristics (CAREFALL Triage Instrument [CTI]). We translated self-reported medications to anatomical therapeutic chemical (ATC) codes (at the second level). Univariate logistic regression analysis was performed to explore the association between medication classes and the outcome parameter (recurrent fall). Multivariate logistic regression was used to assess the associations after adjustment to potential confounders.

Results

In total 2,258 patients participated in our study, of whom 39 % (873) had sustained two or more falls within the previous year. After adjustment for the potential confounders, drugs for acid-related disorders (adjusted odds ratio [aOR] 1.29; 95 % CI 1.03–1.60), analgesics (aOR 1.22; 95 % CI 1.06–1.41), anti-Parkinson drugs (aOR 1.59; 95 % CI 1.02–2.46), nasal preparations (aOR 1.49; 95 % CI 1.07–2.08), ophthalmologicals (aOR 1.51; 95 % CI 1.10–2.09); antipsychotics (aOR 2.21; 95 % CI 1.08–4.52), and antidepressants (aOR 1.64; 95 % CI 1.13–2.37) remained statistically significantly associated with an ED visit due to a recurrent fall.

Conclusions

Known FRIDs, such as psychotropic drugs, also increase the risk of recurrent falls. However, we found four relatively new classes that showed significant association with recurrent falls. In part, these classes may act as markers of frailty and comorbidity, or they may reflect differences in the risk factors affecting the older, frailer population that tends to sustain recurrent falls. Further investigation is needed to elucidate causes and ways to prevent recurrent falls.

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Acknowledgments

MA, SE, and NVV conceived the study and study design. AS collected the data. AA and SR coordinated the study. MA carried out the data analysis under supervision of AA, NVV, and SE. MA drafted the manuscript. All authors participated in the design, interpreted the data, steered the analysis, and critically read and revised the manuscript. All authors read and approved the final manuscript. The authors thank Karlijn van Stralen (epidemiologist) for her methodological advice.

Conflict of interest

The authors declare that they have no conflicts of interest. No information reported in this manuscript has been previously presented. This research was partly funded by ZonMw (The Netherlands Organization for Health Research and Development) by Grants for the PROFIT (#300020010) and ICOVE (#311020302) projects.

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Authors and Affiliations

  1. Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Marjan Askari, Saied Eslami, Stephanie Medlock & Ameen Abu-Hanna

  2. Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Alice C. Scheffer, Sophia E. de Rooij & Nathalie van der Velde

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  1. Marjan Askari
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  2. Saied Eslami
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  3. Alice C. Scheffer
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Correspondence to Marjan Askari.

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Askari, M., Eslami, S., Scheffer, A.C. et al. Different Risk-Increasing Drugs in Recurrent versus Single Fallers: Are Recurrent Fallers a Distinct Population?. Drugs Aging 30, 845–851 (2013). https://doi.org/10.1007/s40266-013-0110-z

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