Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk

Postgraduate Medicine

Volumn 127, Issue 3, 2015, Pages 330-337

  Zia, Anam ^a   Kamaruzzaman, Shahrul Bahyah ^a   Tan, Maw Pin ^a  

^a UNIVERSITY OF MALAYA   (Malaysia)

Author keywords

Accidental falls; Aged; Inappropriate prescribing; Polypharmacy

Indexed keywords

ANTIARRHYTHMIC AGENT; ANTICONVULSIVE AGENT; ANTIDEPRESSANT AGENT; ANTIPARKINSON AGENT; BENZODIAZEPINE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; CARDIOVASCULAR AGENT; DIGOXIN; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; HYPNOTIC SEDATIVE AGENT; LAXATIVE; NARCOTIC ANALGESIC AGENT; NEUROLEPTIC AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; PSYCHOTROPIC AGENT; VASODILATOR AGENT;

ADVERSE DRUG REACTION; AGING; ARTICLE; DRUG INTERACTION; DRUG MISUSE; EVIDENCE BASED MEDICINE; FALL RISK ASSESSMENT; FALLING; FOLLOW UP; GERIATRIC DISORDER; HUMAN; HYPOTENSION; MEDICATION COMPLIANCE; POLYPHARMACY; PRESCRIPTION; PREVALENCE; RISK FACTOR; SCORING SYSTEM; AGE; AGED; MIDDLE AGED; PREVENTION AND CONTROL; STATISTICS AND NUMERICAL DATA; VERY ELDERLY;

ACCIDENTAL FALLS; AGE FACTORS; AGED; AGED, 80 AND OVER; EVIDENCE-BASED MEDICINE; HUMANS; MIDDLE AGED; POLYPHARMACY; RISK FACTORS;

EID: 84964053084     PISSN: 00325481     EISSN: 19419260     Source Type: Journal    
DOI: 10.1080/00325481.2014.996112     Document Type: Article

References (74)

1. Kwok T, Liddle J, Hastie IR. Postural hypotension and falls. Postgrad Med J 1995;71:278–80.
2. Centers for Disease Control and Prevention. Falls among older adults: an overview. 2013. http://www.cdc.gov/HomeandRecreationalSafety/ Falls/adultfalls.html. Accessed 10 July 2014.
3. World Health Organization. Global report on falls prevention in older age. 2007. http://www.who.int/ageing/projects/falls_prevention_ older_age/en/. Accessed 1 September 2014.
4. von Heideken Wagert P, Gustafson Y, Kallin K, Jensen J, Lundin-Olsson L. Falls in very old people: the population-based Umea 85+ study in Sweden. Arch Gerontol Geriatr 2009;49: 390–6.
5. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35:ii37–41.
6. American Geriatrics Society/British Geriatrics Society. Panel on prevention of falls in older persons. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011;59:148–57.
7. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013;75:51–61.
8. Slabaugh SL, Maio V, Templin M, Abouzaid S. Prevalence and risk of polypharmacy among the elderly in an outpatient setting: a retrospective cohort study in the Emilia-Romagna region, Italy. Drugs Aging 2010;27:1019–28.
9. Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Fam Pract 2007;24:14–19.
10. Schuler J, Duckelmann C, Beindl W, Prinz E, Michalski T, Pichler M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr 2008;120:733–41.
11. Olmos R, Garcia O, Velasco J, de la Rubia A. Prevalence of polypharmacy in older hospitalised patients. Eur J Hosp Pharm 2012;19:242–3.
12. Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Polypharmacy: misleading, but manageable. Clin Interv Aging 2008;3:383–9.
13. Wyles H, Rehman HU. Inappropriate polypharmacy in the elderly. Eur J Intern Med 2005;16:311–13.
14. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007;5:345–51.
15. Aronson JK. Polypharmacy, appropriate and inappropriate. Br J Gen Pract 2006;56:484–5.
16. Kojima T, Akishita M, Kameyama Y, et al. High risk of adverse drug reactions in elderly patients taking six or more drugs: analysis of inpatient database. Geriatr Gerontol Int 2012;12:761–2.
17. Steinman MA, Seth Landefeld C, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006;54:1516–23.
18. Brager R, Sloand E. The spectrum of polypharmacy. Nurse Pract 2005;30:44–50.
19. Baranzini F, Diurni M, Ceccon F, et al. Fall-related injuries in a nursing home setting: is polypharmacy a risk factor? BMC Health Serv Res 2009;9:228.
20. Buatois S, Perret-Guillaume C, Gueguen R, et al. A simple clinical scale to stratify risk of recurrent falls in community-dwelling adults aged 65 years and older. Phys Ther 2010;90:550–60.
21. Freeland KN, Thompson AN, Zhao Y, Leal JE, Mauldin PD, Moran WP. Medication use and associated risk of falling in a geriatric outpatient population. Ann Pharmacother 2012;46:1188–92.
22. Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 2001;54:837–44.
23. Hovstadius B, Hovstadius K, Éstrand B, Petersson G. Increasing polypharmacy—an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol 2010;10:1–8.
24. Hiitola PK, Enlund H, Sulkava RO, Hartikainen SA. Changes in the use of cardiovascular medicines in the elderly aged 75 years or older – a population-based Kuopio 75+ study. J Clin Pharm Ther 2007;32:253–9.
25. Rittmannsberger H. The use of drug monotherapy in psychiatric inpatient treatment. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:547–51.
26. Swanenburg J, de Bruin ED, Uebelhart D, Mulder T. Falls prediction in elderly people: a 1-year prospective study. Gait Posture 2010;31:317–21.
27. Onder G, Petrovic M, Tangiisuran B, et al. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med 2010;170:1142–8.
28. McDonald MV, Peng TR, Sridharan S, et al. Automating the medication regimen complexity index. J Am Med Inform Assoc 2013;20:499–505.
29. Turnheim K. Drug therapy in the elderly. Exp Gerontol 2004;39:1731–8.
30. Nickel CH, Ruedinger JM, Messmer AS, et al. Drug-related emergency department visits by elderly patients presenting with nonspecific complaints. Scand J Trauma Resusc Emerg Med 2013;21:15.
31. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003;289:1107–16.
32. Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007;63:187–95.
33. Mamun K, Lien CT, Goh-Tan CY, Ang WS. Polypharmacy and inappropriate medication use in Singapore nursing homes. Ann Acad Med Singapore 2004;33:49–52.
34. O’Mahony D, Gallagher PF. Inappropriate prescribing in the older population: need for new criteria. Age Ageing 2008;37:138–41.
35. Opondo D, Eslami S, Visscher S, et al. Inappropriateness of medication prescriptions to elderly patients in the primary care setting: a systematic review. PLoS One 2012;7:e43617.
36. Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA 2003;289:1652–8.
37. Dell’osso B, Lader M. Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal. Eur Psychiatry 2013;28:7–20.
38. Briesacher BA, Limcangco MR, Simoni-Wastila L, et al. The quality of antipsychotic drug prescribing in nursing homes. Arch Intern Med 2005;165:1280–5.
39. Callisaya ML, Sharman JE, Close J, Lord SR, Srikanth VK. Greater daily defined dose of antihypertensive medication increases the risk of falls in older people – a population-based study. J Am Geriatr Soc 2014;62:1527–33.
40. McLachlan AJ, Pont LG. Drug metabolism in older people – a key consideration in achieving optimal outcomes with medicines. J Gerontol A Biol Sci Med Sci 2012;67:175–80.
41. Noble RE. Drug therapy in the elderly. Metabolism 2003;52:27–30.
42. Wu TY, Chie WC, Yang RS, Liu JP, Kuo KL, Liaw CK. Factors associated with falls among community-dwelling older people in Taiwan. Ann Acad Med Singapore 2013;42:320–7.
43. Shuto H, Imakyure O, Matsumoto J, et al. Medication use as a risk factor for inpatient falls in an acute care hospital: a casecrossover study. Br J Clin Pharmacol 2010;69:535–42.
44. Coutaz M, Iglesias K, Morisod J. Is there a risk of orthostatic hypotension associated with antihypertensive therapy in geriatric inpatients? Eur Geriatr Med 2012;3:1–4.
45. Milos V, Bondesson A, Magnusson M, Jakobsson U, Westerlund T, Midlov P. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatr 2014;14:40.
46. Anonymous Guidelines for the prevention of falls in older persons. American Geriatric Society, British Geriatric Society and American Acadmy of Orhtopaedic surgeons Pannel on Falls Prevention [see comment]. J Am Geriatr Soc 2001;49:664–72.
47. Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study. J Gen Intern Med 2010;25:141–6.
48. Gnjidic D, Le Couteur DG, Pearson SA, et al. High risk prescribing in older adults: prevalence, clinical and economic implications and potential for intervention at the population level. BMC Public Health 2013;13:115.
49. 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 2014;31:225–32.
50. Coimbra AMV, Ricci NA, Coimbra IB, Costallat LTL. Falls in the elderly of the Family Health Program. Arch Gerontol Geriatr 2010;51:317–22.
51. Sorock GS, Quigley PA, Rutledge MK, et al. Central nervous system medication changes and falls in nursing home residents. Geriatr Nurs 2009;30:334–40.
52. Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 2003;327:712–17.
53. Kojima T, Akishita M, Nakamura T, et al. Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 2012;12:425–30.
54. Damian J, Pastor-Barriuso R, Valderrama-Gama E, de Pedro-Cuesta J. Factors associated with falls among older adults living in institutions. BMC Geriatr 2013;13:6.
55. Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med 2014;174:588–95.
56. Denneboom W, Dautzenberg MG, Grol R, De Smet PA. Analysis of polypharmacy in older patients in primary care using a multidisciplinary expert panel. Br J Gen Pract 2006;56:504–10.
57. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging 2008;25:1021–31.
58. van der Velde N, Stricker BH, Pols HA, van der Cammen TJ. Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol 2007;63:232–7.
59. Rothschild JM, Mann K, Keohane CA, et al. Medication safety in a psychiatric hospital. Gen Hosp Psychiatry 2007;29:156–62.
60. Salonoja M, Salminen M, Vahlberg T, Aarnio P, Kivel_ SL. Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment. Arch Gerontol Geriatr 2012;54:160–7.
61. van der Cammen TJ, Rajkumar C, Onder G, Sterke CS, Petrovic M. Drug cessation in complex older adults: time for action. Age Ageing 2014;43:20–5.
62. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a homebased exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc 1999;47:850–3.
63. Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol 2006;61:218–23.
64. Mizukami S, Arima K, Abe Y, et al. Falls are associated with stroke, arthritis and multiple medications among communitydwelling elderly persons in Japan. Tohoku J Exp Med 2013;231:299–303.
65. 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;23:753–8.
66. Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012;65:989–95.
67. Formiga F, Navarro M, Duaso E, et al. Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone 2008;43:941–4.
68. Corsinovi L, Bo M, Ricauda Aimonino N, et al. Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. Arch Gerontol Geriatr 2009;49:142–5.
69. Veehof L, Stewart R, Haaijer-Ruskamp F, Jong BM. The development of polypharmacy. A longitudinal study. Fam Pract 2000;17:261–7.
70. Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women’s Heart and Health Study. Age Ageing 2010;39: 51–6.
71. Bloch F, Thibaud M, Tournoux-Facon C, et al. Estimation of the risk factors for falls in the elderly: can meta-analysis provide a valid answer? Geriatr Gerontol Int 2013;13:250–63.
72. Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009;169:1952–60.
73. 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;47:30–9.
74. 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;47:40–50.