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

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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.

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References

  1. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med. 2004;164:305–12.

    Article  PubMed  Google Scholar 

  2. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä S-L, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55:809–17.

    Article  PubMed  Google Scholar 

  3. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Rothberg MB, Herzig SJ, Pekow PS, Avrunin J, Lagu T, Lindenauer PK. Association between sedating medications and delirium in older inpatients. J Am Geriatr Soc. 2013;61:923–30.

    Article  PubMed  Google Scholar 

  5. Rolita L, Spegman A, Tang X, Cronstein BN. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults. J Am Geriatr Soc. 2013;61:335–40.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ray WA, Thapa PB, Gideon P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc. 2000;48:682–5.

    Article  CAS  PubMed  Google Scholar 

  7. Hubbard R, Farrington P, Smith C, Smeeth L, Tattersfield A. Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol. 2003;158:77–84.

    Article  PubMed  Google Scholar 

  8. Nishtala MPS, Hilmer SN, McLachlan AJ, Hannan PJ, Chen TF. Impact of residential medication management reviews on drug burden index in aged-care homes. Drugs Aging. 2009;26:677–86.

    Article  PubMed  Google Scholar 

  9. Hilmer SN, Mager DE, Simonsick EM, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167:781–7.

    Article  PubMed  Google Scholar 

  10. Gnjidic D, Cumming RG, Le Couteur DG, et al. Drug burden index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68:97–105.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lowry E, Woodman RJ, Soiza RL, Hilmer SN, Mangoni AA. Drug burden index, physical function, and adverse outcomes in older hospitalized patients. J Clin Pharmacol. 2012;52:1584–91.

    Article  PubMed  Google Scholar 

  12. Hilmer SN, Mager DE, Simonsick EM, et al. Drug burden index score and functional decline in older people. Am J Med. 2009;122(1142–1149):e1142.

    Article  Google Scholar 

  13. Schluter PJ, Ahuriri-Driscoll A, Anderson TJ, et al. Comprehensive clinical assessment of home-based older persons within New Zealand: an epidemiological profile of a national cross-section. Aust N Z J Public Health. 2016;40:349–55.

    Article  PubMed  Google Scholar 

  14. Hirdes JP, Ljunggren G, Morris JN, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nishtala P, Ndukwe H, Chyou TY, Salahudeen M, Narayan S. An overview of pharmacoepidemiology in New Zealand: medical databases, registries and research achievements. N Z Med J. 2017;130:52–61.

    PubMed  Google Scholar 

  16. Nishtala PS, Jamieson HJ. New Zealand interRAI: a resource for examining health outcomes in geriatric pharmacoepidemiology. J Am Geriatr Soc. 2017;65:876–7.

    Article  PubMed  Google Scholar 

  17. Gnjidic D, Cumming RG, Le Couteur DG, Handelsman DJ, Naganathan V, Abernethy DR, et al. Drug Burden Index and physical function in older Australian men. Br J Clin Pharmacol. 2009;68:97–105.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hilmer SN, Mager DE, Simonsick EM, Ling SM, Windham BG, Harris TB, Shorr RI, Bauer DC, Abernethy DR, ABC Health Study. Drug burden index score and functional decline in older people. Am J Med. 2009;122(12):1142–9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rolita L, Spegman A, Tang X, Cronstein BN. Greater number of narcotic analgesic prescriptions for osteoarthritis is associated with falls and fractures in elderly adults. J Am Geriatr Soc. 2013;61:335–40.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wilson NM, Hilmer SN, March LM, et al. Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc. 2011;59:875–80.

    Article  PubMed  Google Scholar 

  21. Schwarz G. Estimating the dimension of a model. Ann Stat. 1978;6:461–4.

    Article  Google Scholar 

  22. Sun GW, Shook TL, Kay GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol. 1996;49(8):907–16.

    Article  CAS  PubMed  Google Scholar 

  23. Nishtala PS, Narayan SW, Wang T, Hilmer SN. Associations of drug burden index with falls, general practitioner visits, and mortality in older people. Pharmacoepidemiol Drug Saf. 2014;23(7):753–8.

    Article  PubMed  Google Scholar 

  24. 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(1):40–50.

    Article  CAS  PubMed  Google Scholar 

  25. 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(1):30–9.

    Article  CAS  PubMed  Google Scholar 

  26. Allain H, Bentue-Ferrer D, Polard E, Akwa Y, Patat A. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly. Drugs Aging. 2005;22(9):749–65.

    Article  PubMed  Google Scholar 

  27. Schneeweiss S, Wang PS. Association between SSRI use and hip fractures and the effect of residual confounding bias in claims database studies. J Clin Psychopharmacol. 2004;24(6):632–8.

    Article  PubMed  Google Scholar 

  28. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol. 1992;45(2):197–203.

    Article  Google Scholar 

  29. Francis RM. Falls and fractures. Age Ageing. 2001;30:25–8.

    Article  PubMed  Google Scholar 

  30. Woolf AD, Åkesson K. Preventing fractures in elderly people. BMJ. 2003;327:89–95.

    Article  PubMed  PubMed Central  Google Scholar 

  31. interRAI.HC. interRAI Home Care. 2016. http://interrai.org/home-care.html. Accessed 9 May 2016.

  32. Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN. Drug burden index in older adults: theoretical and practical issues. Clin Interv Aging. 2014;9:1503.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gnjidic D, Couteur DGL, Abernethy DR, Hilmer SN. Drug burden index and Beers criteria: impact on functional outcomes in older people living in self-care retirement Villages. J Clin Pharmacol. 2012;52:258–65.

    Article  PubMed  Google Scholar 

  34. Skelton D, Todd C. What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? WHO Regional Office for Europe; 2004. http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf. Accessed 20 May 2016.

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Authors and Affiliations

  1. Department of Medicine, University of Otago, Christchurch: Geriatrician, Burwood Hospital, Christchurch, New Zealand

    Hamish A. Jamieson

  2. School of Pharmacy, University of Otago, Dunedin, New Zealand

    Prasad S. Nishtala

  3. Canterbury District Health Board, Christchurch, New Zealand

    Richard Scrase

  4. Department of Medicine, University of Otago, Christchurch, New Zealand

    Joanne M. Deely

  5. University of Otago, Christchurch, New Zealand

    Rebecca Abey-Nesbit

  6. University of Auckland, Auckland, New Zealand

    Martin J. Connolly

  7. Waitemata District Health Board, Auckland, New Zealand

    Martin J. Connolly

  8. The University of Sydney, Sydney, Australia

    Sarah N. Hilmer

  9. Office of Clinical Pharmacology at the Food and Drug Administration, Silver Spring, MD, USA

    Darrell R. Abernethy

  10. University of Canterbury–Te Whare Wānanga o Waitaha, Christchurch, New Zealand

    Philip J. Schluter

  11. School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia

    Philip J. Schluter

Authors
  1. Hamish A. Jamieson
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  2. Prasad S. Nishtala
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Corresponding author

Correspondence to Hamish A. Jamieson.

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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.

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Jamieson, H.A., Nishtala, P.S., Scrase, R. et al. Drug Burden and its Association with Falls Among Older Adults in New Zealand: A National Population Cross-Sectional Study. Drugs Aging 35, 73–81 (2018). https://doi.org/10.1007/s40266-017-0511-5

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  • DOI: https://doi.org/10.1007/s40266-017-0511-5

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