Medications and Falls – Abstracts
This document contains all abstracts for publications relating to fractures and head injuries from October 2019 through to December 2019. These abstracts have been sourced from SafetyLit.org and include only those relevant to falls prevention.
SafetyLit provides weekly abstracts of peer reviewed articles from researchers who work in the more than 30 distinct professional disciplines relevant to preventing and researching unintentional injuries, violence, and self-harm. Each week citations and summaries of about 400 articles and reports are included in a PDF document or through an RSS subscription.
The effect of therapeutic exercises on balance, quality of life and pain in patients who were receiving neurotoxic chemotherapy
Bahar-Ozdemir Y, Akyuz G, Kalkandelen M, Yumuk F. Am. J. Phys. Med. Rehabil. 2019; ePub(ePub): ePub.
Marmara University Medical School, Department of Clinical Oncology, Istanbul, Turkey. (Copyright © 2019, Lippincott Williams and Wilkins)
DOI 10.1097/PHM.0000000000001324 PMID 31592877
OBJECTIVE: To evaluate the effect of lower extremity strengthening and balance exercises on balance, quality of life (QoL) and neuropathic pain (NP) of the cancer patients receiving neurotoxic chemotherapy (N-CTX).
DESIGN: Patients who were planning to receive N-CTX agents were included in the first group. They were trained before the N-CTX sessions with the 10-week home-based exercise program including lower extremity strengthening and balance exercises. The second group of patients who had received the 3 cycle of N-CTX had no exercise program. Both groups were evaluated after the 3 cycle. Neurocom Balance Master and Berg Balance Scale (BBS) were used to evaluate balance. The NP was questioned by PainDETECT questionnaire (PD-Q) and the QoL was assessed with EORTC QLQ-C30.
RESULTS: Sixty patients were admitted to this study. Twenty-four patients were in the exercise group (F=14, M=10) and 36 patients were in the control group (F=17, M=19). Socio-demographic and clinical data of both groups were similar. BBS (p=0.005), EORTC QLQ-C30 global QoL, physical function and emotional status were higher, symptom scores and PD-Q score were lower in the exercise group (p<0.05). Balance tests were different between the groups.
CONCLUSION: Strengthening and balance exercises have a valuable effect on balance, QoL and NP in patients receiving N-CTX.
Serotonin receptor inhibitor is associated with falls independent of frailty in older adults
Lin SM, Borges MK, de Siqueira ASS, Biella MM, Jacob-Filho W, Cesari M, Voshaar RCO, Aprahamian I. Aging Ment. Health 2019; ePub(ePub): ePub.
Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí , Jundiaí , Brazil.
(Copyright © 2019, Informa – Taylor and Francis Group)
DOI 10.1080/13607863.2019.1675143 PMID 31603040
Objectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.
Depression; antidepressants; falls; frailty; older adults
The Fall Risk with Alpha blockers Given InitiaL dose or Elderly status (FRAGILE) study
McDonnell CC, Rogers KC, Regen SM, Finks SW. Ann. Pharmacother. 2019; ePub(ePub): ePub.
University of Tennessee College of Pharmacy, Memphis, TN, USA.
(Copyright © 2019, Harvey Whitney Books)
DOI 10.1177/1060028019880305 PMID 31578074
Background: α-1 adrenergic antagonists are commonly prescribed, but there is question regarding their safety in patients at increased fall risk. Objective: The purpose of the FRAGILE study was to determine the risk for developing adverse drug events (ADEs) in veterans prescribed α-1 blockers. Methods: A single-center, retrospective, observational cohort analysis was conducted of veterans newly initiated on α-1 antagonists. Veterans were categorized into at-risk (patients who met at least 1 of 2 criteria: age 65 or older or high initial dose of α blockade) or control (veterans without either risk factor) groups. The primary outcome was the composite all-cause ADEs, including hospitalizations or emergency department (ED) visits. Secondary outcomes included number of fall-related ADEs and medication discontinuation rates with follow-up for 12 months. Results: A total of 300 veterans were evaluated. There was no significant difference in the composite outcome of all-cause ED visits between at-risk (n = 169) versus control (n = 131) groups (0.81 vs 1.17, P = 0.09) or all-cause hospitalizations (0.28 vs 0.39, P = 0.25). Seventy-three veterans in the at-risk group experienced an all-cause ADE versus 64 in the control group (P = 0.36). No significant differences in secondary outcomes were found. Fall-related side effects occurred in 8% of the total cohort. Conclusion and Relevance: Rates of all-cause or fall-related ADEs were not significantly different. An 8% discontinuation rate resulting from fall-related ADEs and high rates of coadministered medications that could increase fall risk. Pharmacists can play a key role in optimizing α-1 blocker administration.
elderly; fall; prazosin; syncope; α-blocker
The prevalence of Beers criteria medication use and associations with falls in geriatric patients at a Level 1 trauma center
Walker BS, Collier BR, Bower KL, Lollar DI, Faulks ER, Matos M, Nussbaum MS, Hamill ME. Am. Surg. 2019; 85(8): 877-882.
(Copyright © 2019, Southeastern Surgical Congress)
DOI unavailable PMID 31560307
The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients. We conducted a retrospective analysis of PIM use in all geriatric patients evaluated at our Level 1 trauma center between 2014 and 2017. Patients were identified from our trauma database. Pre-admission medication use was determined through medication reconciliation from our electronic medical record (EMR). Patients not undergoing medication reconciliation were excluded. After initial analysis, patients were stratified by age into three groups: 65 to 74, 75 to 84, and ≥85 years. Multivariate logistic regression analyses were used to calculate odds ratios of falls for specific PIMs. In all, 2181 patients met the inclusion criteria. Overall, 71.2 per cent of geriatric trauma patients were prescribed at least one PIM-73.1 per cent of falls compared with 68.6 per cent for other mechanisms. Specific PIM use varied by age group. PIMs associated with fall risk in all patients included antipsychotics, benzodiazepines, and diclofenac. For those aged 65 to 74 years, antihistamines, diclofenac, proton pump inhibitors, and promethazine were associated. In those aged 75 to 84 years, alprazolam, antipsychotics, benzodiazepines, cyclobenzaprine, diclofenac, and muscle relaxants were implicated. No significant associations were found for patients aged ≥85 years. PIM use at our trauma center seems to be rampant and well above the national average. Geriatric falls were associated with using ≥1 PIM and multiple specific PIMs implicated. We are designing a targeted educational program for local primary care physicians (PCPs) that will attempt to decrease geriatric PIM use.
Evidence synthesis based on non-randomised studies-a critical review of studies leading to conclusions on fall risk properties of loop diuretics/beta-blockers
Wallerstedt SM, Hoffmann M. Eur. J. Clin. Pharmacol. 2019; ePub(ePub): ePub.
The NEPI Foundation – Swedish Network for Pharmacoepidemiology, Linköping University, Linköping, Sweden.
(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)
DOI 10.1007/s00228-019-02754-6 PMID 31599346
PURPOSE: To describe methodological and reporting issues in non-randomised comparative drug safety studies pooled in meta-analyses, with focus on confounding by indication.
METHODS: All studies included in statistically significant meta-analyses in a recent publication investigating fall risk properties of cardiovascular drugs were reviewed. Study characteristics were extracted and assessed.
RESULTS: Nine studies, including between 498 and 321,995 individuals, contributed data to the significant meta-analyses in which loop diuretics and beta-blockers were associated with falls, five published in 2015. Five individual studies reported a statistically significant association. In the five cohort studies, characteristics of exposed vs unexposed individuals were either not reported (n = 3) or differed substantially regarding morbidity (n = 2). Drug treatment was determined at baseline, and data on falls were collected for up to 2 years thereafter. Out of the four case-control studies, the cases and controls in only one study were matched for morbidity. Morbidity characteristics of fallers compared with non-fallers were either not reported (n = 2) or they differed (n = 1) or were reported according to the matched- for diseases (n = 1). Confounding by indication was explicitly discussed in two studies. None of the abstract conclusions considered causality issues or the possibility of confounding by indication.
CONCLUSIONS: Confounding by indication is a major issue in non-randomised comparative drug safety studies, a problem which may be concealed in meta-analyses. To enhance such research, compared groups need to be balanced regarding relevant factors including morbidities and characteristics adequately reported. Confounding by indication needs to be explicitly discussed and highlighted in the abstract conclusion.
Cardiovascular drugs; Confounding by indication; Drug safety; Evidence-based medicine; Falls; Pharmacoepidemiology
Predictors of hip fracture despite treatment with bisphosphonates among frail older adults
Zullo AR, Sorial MN, Lee Y, Lary CW, Kiel DP, Berry SD. J. Am. Geriatr. Soc. 2019; ePub(ePub): ePub.
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
(Copyright © 2019, John Wiley and Sons)
DOI 10.1111/jgs.16176 PMID 31580488
OBJECTIVES: Bisphosphonates are effective at preventing hip fractures among older adults, yet many patients still fracture while on treatment and may benefit from additional preventive interventions. Little data are specifically available to target such efforts among bisphosphonate users. We aimed to identify predictors of hip fracture unique to frail older adults initiating pharmacologic treatment for osteoporosis.
DESIGN: Retrospective cohort using 2008-2013 linked national Minimum Data Set assessments, Medicare claims, and nursing home (NH) facility data. SETTING: NHs in the United States. PARTICIPANTS: Long-stay NH residents 65 years or older who initiated treatment with a bisphosphonate (N = 17 753). Estimates for bisphosphonate initiators were contrasted with those for calcitonin initiators (control group; N = 5348). MEASUREMENTS: Hospitalized hip fracture outcomes were measured using Part A claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for 36 a priori selected potential predictors.
RESULTS: The mean (SD) age of the study population was 84 (8) years, 85% were women, and 51% had moderate to severe cognitive impairment. Predictors associated with a higher risk of hip fracture despite bisphosphonate use included age 75 years or older to 85 years (vs ≥65 to <75 y; HR = 1.25; 95% CI = 1.02-1.55), female sex (HR = 1.33; 95% CI = 1.06-1.67), white race (vs black race (HR = 1.87; 95% CI = 1.36-2.58), and body mass index = 18.5-24.9 (vs ≥30; HR = 1.93; 95% CI = 1.53-2.42). Independent ability to transfer (vs total dependence; HR = 3.11; 95% CI = 1.83-5.30) and occasional urinary incontinence (vs frequent; HR = 1.45; 95% CI = 1.18-1.78) were also important predictors. Dementia, diabetes, psychoactive drug use, and other characteristics were not associated with post-prescribing hip fracture. Predictors did not differ between bisphosphonate and calcitonin users.
CONCLUSION: Predictors of hip fracture among frail older adults did not differ between those who were new users of bisphosphonates vs calcitonin. Given the absence of risk factors unique to bisphosphonate users, targeting of fracture prevention efforts should extend beyond pharmacologic therapy to include existing nonpharmacologic therapies, particularly fall prevention strategies.