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Prevalence and Impact of Fall-Risk-Increasing Drugs, Polypharmacy, and Drug–Drug Interactions in Robust Versus Frail Hospitalised Falls Patients: A Prospective Cohort Study

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Abstract

Background

Several measures of medication exposure are associated with adverse outcomes in older people. Exposure to and the clinical outcomes of these measures in robust versus frail older inpatients are not known.

Objective

In older robust and frail patients admitted to hospital after a fall, we investigated the prevalence and clinical impact of fall-risk-increasing drugs (FRIDs), total number of medications, and drug–drug interactions (DDIs).

Methods

Patients ≥60 years of age admitted with a fall to a tertiary referral teaching hospital in Sydney were recruited and frailty was assessed. Data were collected at admission, discharge, and 2 months after admission.

Results

A total of 204 patients were recruited (mean age 80.5 ± 8.3 years), with 101 robust and 103 frail. On admission, compared with the robust, frail participants had significantly higher mean ± SD number of FRIDs (frail 3.4 ± 2.2 vs. robust 1.6 ± 1.5, P < 0.0001), total number of medications (9.8 ± 4.3 vs. 4.4 ± 3.3, P < 0.0001), and DDI exposure (35 vs. 5 %, P = 0.001). Number of FRIDs on discharge was significantly associated with recurrent falls [odds ratio (OR) 1.7 (95 % confidence interval [CI] 1.3–2.1)], which were most likely to occur with 1.5 FRIDs in the frail and 2.5 FRIDs in the robust. Number of medications on discharge was also associated with recurrent falls [OR 1.2 (1.0–1.3)], but DDIs were not.

Conclusion

Exposure to FRIDs and other measures of high-risk medication exposures is common in older people admitted with falls, especially the frail. Number of FRIDs and to a lesser extent total number of medicines at discharge were associated with recurrent falls.

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Acknowledgments

We gratefully acknowledge and appreciate the Emergency Departments’ Research Volunteers at the Royal North Shore Hospital for their contributions to data collection.

Funding

This study was supported by the Geoff and Elaine Penney Ageing Research Unit, Royal North Shore Hospital. Danijela Gnjidic is supported by a National Health and Medical Research Council Early Career Fellowship.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. University of Sydney, Northern Clinical School, Sydney, NSW, Australia

    Alexander Bennett, Danijela Gnjidic, Mark Gillett, Peter Carroll & Sarah Hilmer

  2. Royal North Shore Hospital, Clinical Pharmacology and Aged Care, Sydney, NSW, Australia

    Alexander Bennett, Danijela Gnjidic & Sarah Hilmer

  3. Kolling Institute of Medical Research, Ageing and Pharmacology, Sydney, NSW, Australia

    Alexander Bennett, Danijela Gnjidic & Sarah Hilmer

  4. Royal North Shore Hospital, Emergency Department, Sydney, NSW, Australia

    Mark Gillett

  5. University of Sydney, Faculty of Pharmacy, Sydney, NSW, Australia

    Danijela Gnjidic

  6. University of Sydney, Pharmacology Department, Sydney, NSW, Australia

    Peter Carroll & Slade Matthews

  7. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden

    Kristina Johnell & Johan Fastbom

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  1. Alexander Bennett
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Correspondence to Alexander Bennett.

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Bennett, A., Gnjidic, D., Gillett, M. et al. Prevalence and Impact of Fall-Risk-Increasing Drugs, Polypharmacy, and Drug–Drug Interactions in Robust Versus Frail Hospitalised Falls Patients: A Prospective Cohort Study. Drugs Aging 31, 225–232 (2014). https://doi.org/10.1007/s40266-013-0151-3

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  • DOI: https://doi.org/10.1007/s40266-013-0151-3

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