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Background: Drug use evaluation as an intervention approach for fall prevention has an effect on most drug-related outcomes. Geriatric assessment clinic provides comprehensive care in elderly patients. All prescribed or non-prescribed medications were evaluated by pharmacists.
Objective: To study the drug and drug-related problem among elderly patients with history of falling.
Methods: This is a cross-sectional study of elderly patients with history of fallings. Demographic data, health information, history of falls, and drugs use evaluation were obtained from their medical records in year 2010 to 2020. Linear regression model was used to examine the multivariate correlates to number of fallings.
Results: A total of 183 patients with history of falling were studied. Of this, 97 had recurrent falls. Most patients (77%) had more than 5 underlying diseases and over half (55%) had dementia. Drug-related problem were found 69.4%, 4 in 5 of patients used 5 types of the medications or more. The diabetes drugs were found to increase risk of recurrent falls significantly (OR [95% CI], 2.11 [1.03 - 4.33]; P < .05).
Conclusions: Most elderly patient with history of falling have drug-related problem (69.4%) and multiple morbidities including dementia. The diabetes drugs were 2 times significantly increased risk of recurrent falls. This study highlights the important of drugs management in this vulnerable group of elderly patients.
Franceschi C, Garagnani P, Morsiani C, et al. The Continuum of aging and age-related diseases: common mechanisms but different rates. Front Med (Lausanne). 2018;5:61. doi:10.3389/fmed.2018.00061
Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: balancing evidence-based medicine against falls risk. Postgrad Med. 2015;127(3):330-337. doi:10.1080/00325481.2014.996112
O'Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505. doi:10.1136/bmjopen-2015-010505
Morin L, Calderon Larrañaga A, Welmer AK, Rizzuto D, Wastesson JW, Johnell K. Polypharmacy and injurious falls in older adults: a nationwide nested case-control study. Clin Epidemiol. 2019;11:483-493. doi:10.2147/CLEP.S201614
Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ Open. 2017;7(10):e016358. doi:10.1136/bmjopen-2017-016358
Hämmerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet. 1998;35(1):49-64. doi:10.2165/00003088-199835010-00004
Reeve E, Trenaman SC, Rockwood K, Hilmer SN. Pharmacokinetic and pharmacodynamic alterations in older people with dementia. Expert Opin Drug Metab Toxicol. 2017;13(6):651-668. doi:10.1080/17425255.2017.1325873
Mohamed MR, Ramsdale E, Loh KP, et al. Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and meta-analysis. Oncologist. 2020;25(1):e94-e108. doi:10.1634/theoncologist.2019-0406
de Vries M, Seppala LJ, Daams JG, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: I. cardiovascular drugs. J Am Med Dir Assoc. 2018;19(4):371.e1-371.e9. doi:10.1016/j.jamda.2017.12.013
Seppala LJ, van de Glind EMM, Daams JG, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: III. Others. J Am Med Dir Assoc. 2018;19(4):372.e1-372.e8. doi:10.1016/j.jamda.2017.12.099
Boongird C, ed. Burden of Fall in Older Adults and Their Families. In: Falling in the Older Adults: Prevention and Management in Family Medicine. Textbook Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2019:15-23.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701-1707. doi:10.1056/NEJM198812293192604
Maneeprom N, Taneepanichskul S, Panza A. Falls among physically active elderly in senior housings, Bangkok, Thailand: situations and perceptions. Clin Interv Aging. 2018;13:2149-2159. doi:10.2147/CIA.S175896
Prasert V, Akazawa M, Shono A, et al. Applying the Lists of Risk Drugs for Thai Elderly (LRDTE) as a mechanism to account for patient age and medicine severity in assessing potentially inappropriate medication use. Res Social Adm Pharm. 2018;14(5):451-458. doi:10.1016/j.sapharm.2017.05.012
Thiamwong L, Suwanno J. Fear of falling and related factors in a community-based study of people 60 years and older in Thailand. Int J Gerontol. 2017;11(2):80-84. doi:10.1016/j.ijge.2016.06.003
Boongird C, Thamakaison S, Krairit O. Impact of a geriatric assessment clinic on organizational interventions in primary health-care facilities at a university hospital. Geriatr Gerontol Int. 2011;11(2):204-210. doi:10.1111/j.1447-0594.2010.00671.x
Fuller GF. Falls in the elderly. Am Fam Physician. 2000;61(7):2159-2174.
Alberdi F, García I, Atutxa L, Zabarte M; Trauma and Neurointensive Care Work Group of the SEMICYUC. Epidemiology of severe trauma. Med Intensiva. 2014;38(9):580-588. doi:10.1016/j.medin.2014.06.012
Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health. 1992;82(7):1020-1023. doi:10.2105/ajph.82.7.1020
Ruangritchankul S, Krairit O, Putthipokin K, Chansirikarnjana S, Assavapokee T, Sraium S. Polypharmacy among older adults in Outpatient Clinic, Internal Medicine Department, Ramathibodi Hospital. Thai J Toxicol. 2018;33(1):35-50.
Yang Y, Hu X, Zhang Q, Zou R. Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis. Age Ageing. 2016;45(6):761-767. doi:10.1093/ageing/afw140