Dataset Information

Joint effects of advancing age and number of potentially inappropriate medication classes on risk of falls in Medicare enrollees.

ABSTRACT:

Background

Injurious falls among older adults are both common and costly. The prevalence of falls is known to increase with age and with use of fall-risk drugs/potentially inappropriate medications (FRD/PIM). Little is known about the joint effects of these two risk factors.

Methods

Data for 2013-2015 were obtained from the Truven Health MarketScan® Medicare database comprising utilization and eligibility (enrollment) data for approximately 4 million enrollees annually. A case-control design was used to compare enrollees aged 65-99?years diagnosed with >?1 fall event (n?=?110,625) with enrollees without falls (n?=?1,567,412). An exploratory analysis of joint age-FRD/PIM effects on fall risks was based on number needed to harm (NNH) calculations for each FRD/PIM therapy class count (compared with 0 FRD/PIMs), stratified by age group. Logistic regression analyses adjusted for demographics, comorbidities, and fracture history, measured in the 1?year prior to the fall date (cases) or a randomly assigned date (controls).

Results

For each FRD/PIM class count, NNH values decreased with older age (e.g., for 1 FRD/PIM class: from NNH?=?333 for ages 65-74?years to NNH?=?83 for ages 90-99?years; for 2 FRD/PIM classes: from NNH?=?91 for ages 65-74?years to NNH?=?38 for ages 90-99?years). NNH decreased to ?6 classes for age 65-74?years, >?5 classes for age 75-84?years, and > 4 classes for age 85-99?years. Adjusted odds of falling were increased for age-FRD/PIM combinations with smaller NNH values: adjusted odds ratio (AOR)?=?1.127 (95% confidence interval [CI]?=?1.098-1.156) for NNH?=?83-91; AOR?=?1.427 (95% CI?=?1.398-1.456) for NNH?=?17-48; AOR?=?1.983 (1.9034-2.032) for NNH ConclusionFRD/PIM use and age appear to have joint effects on fall risk. Older adults at high risk, indicated by small NNH, may be appropriate for fall prevention initiatives, and clinicians may wish to consider decreasing the number of FRD/PIMs utilized by these patients.

SUBMITTER: Early NK

PROVIDER: S-EPMC6642496 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Joint effects of advancing age and number of potentially inappropriate medication classes on risk of falls in Medicare enrollees.

Early Nicole K NK Fairman Kathleen A KA Hagarty Jacqueline M JM Sclar David A DA

BMC geriatrics 20190719 1

<h4>Background</h4>Injurious falls among older adults are both common and costly. The prevalence of falls is known to increase with age and with use of fall-risk drugs/potentially inappropriate medications (FRD/PIM). Little is known about the joint effects of these two risk factors.<h4>Methods</h4>Data for 2013-2015 were obtained from the Truven Health MarketScan® Medicare database comprising utilization and eligibility (enrollment) data for approximately 4 million enrollees annually. A case-con ...[more]

PMID: 31324232

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Project description:BackgroundPotentially inappropriate medications (PIMs) are prevalent in older adults with dementia and subsequent falls or fall-related injuries. The present study determined the risk of falls or fall-related injuries associated with PIM use in older adults with dementia.MethodsThe National Health Insurance Service-Elderly Cohort Database 2.0 (NHIS-ECDB 2.0) was used for this self-controlled case series (SCCS) study. This study included 1430 participants who went through exposure and non-exposure periods of PIM application among patients with dementia and experienced outcome events of falls or fall-related injuries between January 2016 and December 2019. The incidence of falls or fall-related injuries during the exposure and post-exposure periods was compared with that during the non-exposure period. Beers Criteria were used to define PIMs in patients with dementia. Negative binomial regression was conducted. The incidence rate ratio (IRR) was used to determine the risk of falls or fall-related injuries.ResultsDuring the exposure periods in which falls or fall-related injuries occurred, the mean number of PIMs among patients with dementia was 3.76 (SD = 2.99), and the most commonly used PIMs among patients with dementia were first-generation antihistamines (n = 283; 59.1%). Compared to the non-exposure period, the adjusted IRR during the exposure period was 1.57 (95% CI = 1.39-1.76). The risk of falls or fall-related injuries was increased when PIM use in patients with dementia was initiated (1-14 days: IRR = 2.76, 95% CI = 2.31-3.28; 15-28 days: IRR = 1.95, 95% CI = 1.48-2.56; ≥ 29 days: IRR = 1.17, 95% CI = 1.01-1.35). Especially, an increased risk of falls or fall-related injuries was associated with greater PIM use among patients with dementia.ConclusionAmong older adults with dementia, PIMs significantly increase the risk of falls and fall-related injuries. Therefore, strategies should be developed to manage PIM prescriptions in patients with dementia to prevent falls.

Project description:BackgroundMultimorbidity, polypharmacy, and potentially inappropriate medication (PIM) pose challenges for the care of people with cognitive impairment. The aim of the present study is to explore whether multimorbidity, polypharmacy, and PIM predict falls and hospital admissions in a sample of people with cognitive impairment in day-care centers in Germany.MethodsWe used data from the German day-care study (multicenter longitudinal study, n = 433). Multimorbidity was defined as ≥ 2 chronic diseases. Polypharmacy was defined as prescriptions to ≥ 5 drugs. Potentially inappropriate medication was defined as scoring on the PRISCUS list. Binary logistic regression analyses were computed to determine whether multimorbidity, polypharmacy, and potentially inappropriate medication at t0 predicted falls and hospital admissions as outcomes at t1 (six months later).ResultsThe rate of multimorbidity and polypharmacy was 87.8% and 60.3%, respectively. 15.9% of the people with cognitive impairment received PIM / PRISCUS-listed drugs, 43.6% ACB-listed drugs, and 52.7% CNS depressant drugs. Falls and hospital admissions during follow-up were prevalent in 19.4% and 24.7% of the people with cognitive impairment. Both were significantly predicted by the total number of drugs (falls: OR = 1.152, p = 0.001, overall model: p < 0.001; hospital admissions: OR = 1.103, p = 0.020, overall model: p = 0.001), even if regression analyses were controlled for the number of comorbidities.ConclusionsPolypharmacy and potentially inappropriate medication are highly prevalent in people with cognitive impairment in German day-care centers. The number of drugs and appropriateness of medication seem to be crucial for the risk of falls and hospital admissions. Polypharmacy and PIM should be critically reviewed by healthcare providers and avoided as much as and whenever possible.Trial registrationISRCTN16412551, 30 July 2014, registered partly retrospectively.

Dataset Information

Joint effects of advancing age and number of potentially inappropriate medication classes on risk of falls in Medicare enrollees.

Background

Methods

Results

Publications

Joint effects of advancing age and number of potentially inappropriate medication classes on risk of falls in Medicare enrollees.

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