Dataset Information

Association between polypharmacy and falls in older adults: a longitudinal study from England.

ABSTRACT:

Objectives

Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.

Design

Longitudinal cohort study.

Setting

The English Longitudinal Study of Ageing waves 6 and 7.

Participants

5213 adults aged 60 or older.

Main outcome measures

Rates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.

Results

A total of 5213 participants contributed 10?502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9-2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2?years (rate: 175 per 1000 person-years, 95%?CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95%?CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95%?CI 1.11 to 1.31). Using ?4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95%?CI 1.08 to 1.28), whereas using ?10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95%?CI 1.34 to 1.67).

Conclusions

We found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.

SUBMITTER: Dhalwani NN

PROVIDER: S-EPMC5652576 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Publications

Association between polypharmacy and falls in older adults: a longitudinal study from England.

Dhalwani Nafeesa N NN Fahami Radia R Sathanapally Harini H Seidu Sam S Davies Melanie J MJ Khunti Kamlesh K

BMJ open 20171016 10

<h4>Objectives</h4>Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.<h4>Design</h4>Longitudinal cohort study.<h4>Setting</h4>The English Longitudinal Study of Ageing waves 6 and 7.<h4>Participants</h4>5213 adults aged 60 or older.<h4>Main outcome measures</h4>Rates, incidence rate ratio (IRR) and 95% ...[more]

PMID: 29042378

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Project description:IntroductionPrevious studies have suggested that cognitive impairment is associated with falls in older adults. However, the consistency of results among different subgroups defined by multiple characteristics of the elderly has not yet been tested. Additionally, results are inconsistent regarding the effects of different cognitive domains on falls. Therefore, this study sought to use representative data from a nationwide study to better understand the longitudinal association between cognitive impairment and subsequent falls in older adults.MethodsThe current study was conducted based on the China Health and Retirement Longitudinal Study (CHARLS) data of respondents aged ≥60 years in 2015 and the fall data in 2018. The respondents were divided into subgroups according to different demographic characteristics. Multiple logistic regression analysis was conducted to adjust for various confounding factors and evaluate the association between cognitive impairment and falls.ResultsOf the 5,110 respondents included in this study, 1,093 (21.39%) had falls within the last 2 years. A significant association was found between cognitive impairment and subsequent falls (OR = 0.97, 95% CI 0.95-0.99, P = 0.001) after adjusting for all of the covariates related to falls. Analysis of different cognitive domains showed that orientation (OR = 0.94, 95% CI 0.90-0.99, P = 0.013) and memory (OR = 0.93, 95% CI 0.90-0.97, P = 0.001) were significantly associated with falls. In subgroup analysis, the ORs of people aged 60-74 years, male, with lower education level were 0.97 (95% CI 0.95-0.99, P = 0.008), 0.96 (95% CI 0.93-0.98, P = 0.001), and 0.97 (95% CI 0.95-0.99, P = 0.001), respectively, suggesting that the associations were also statistically significant in these subgroups. There was also a significant association both in urban (OR = 0.97, 95% CI 0.95-0.99, P = 0.001) and in rural residents (OR = 0.97, 95% CI 0.95-0.99, P = 0.003).ConclusionsOur results suggest that the associations between cognition and falls vary depending on the different demographic characteristics of older adults. These findings may be useful for designing more accurate identification and intervention for the fall risk for specific high-risk groups.

Project description:BackgroundReduced physical function and polypharmacy (PPha) are two highly prevalent negative effects of aging, which are expected to increase more, since demographic aging is expected to grow rapidly within the next decades. Previous research suggests that polypharmacy (PPha) is a predictor of poor physical function and vice versa in older adults and therefore we conducted a systematic review of the literature to summarize and critically analyze the relationship between physical function and PPha and vice versa in older adults, in order to provide recent scientific evidence.MethodsWe searched MEDLINE and Embase from their inception to 19th October 2018 for English-language observational studies or trials assessing the effect of PPha on physical function and vice versa in older adults. Two investigators independently extracted study data and assessed the quality of the studies, after having screened the available studies from the literature search. Any disagreement was resolved by consensus.ResultsEighteen observational studies met the inclusion criteria. Eight studies assessed the impact of physical function on PPha and ten studies assessed the impact of PPha on physical function. Regarding the studies with PPha measurements as the outcome, all of them, except for one, found that better physical function is associated with lower risk of PPha. Likewise, all the studies with physical function measurements as the outcome, except for one, suggested that PPha is associated with lower physical function.DiscussionEvidence examining the effect of PPha on physical function and vice versa in older adults suggests a strong bidirectional association between these two factors and clinicians should be aware of this strong relationship. The limitations of our study include the high variability in PPha definitions and physical function measures, and the treatment of PPha and physical function as constant instead of time-varying variables in the studies' analyses.

Project description:Background and objectivesMedication exposure is a potential risk factor for falls and subsequent death and functional decline among older adults. However, controversy remains on the best way to assess medication exposure and which approach best predicts falls. The objective of the current study was to examine the association between different measures of medication exposure and falls risk among community-dwelling older adults.Research design and methodsThis retrospective cohort study was conducted using Falls Free PA program data and a linked prescription claims data from Pennsylvania's Pharmaceutical Assistance Contract for the Elderly program. Participants were community-dwelling older adults living in Pennsylvania, United States. Three measures of medication exposure were assessed: (a) total number of regular medications (polypharmacy); (b) counts of potentially inappropriate medications derived from current prescription guidance tools (Fall Risk-Increasing Drugs [FRIDs], Beers Criteria); and (c) medication burden indices based on pharmacologic mechanisms (Anticholinergic Cognitive Burden, Drug Burden Index) all derived from claims data. The associations between the different medication risk measures and self-reported falls incidence were examined with univariate and multivariable negative binomial regression models to estimate incidence rate ratios (IRRs).ResultsOverall 343 older adults were included and there were 236 months with falls during 2,316 activity-adjusted person-months (10.2 falls per 100 activity-adjusted person-months). Of the 6 measures of medication risk assessed in multivariate models, only the use of 2 or more FRIDs (adjusted IRR 1.67 [95% CI: 1.04-2.68]) independently predicted falls risk. Among the 13 FRID drug classes, the only FRID class associated with an increased fall risk was antidepressants.Discussion and implicationsThe presence of multiple FRIDs in a prescription is an independent risk factor for falls, even in older adults with few medications. Further investigation is required to examine whether deprescribing focused on FRIDs effectively prevents falls among this population.

Dataset Information

Association between polypharmacy and falls in older adults: a longitudinal study from England.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Association between polypharmacy and falls in older adults: a longitudinal study from England.

Similar Datasets

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