Mortality and Prevalence of Falls, and their Association with Psychiatric Diagnoses and Psychotropic Medications
DOI:
https://doi.org/10.33192/Smj.2020.54Keywords:
Falls, prevalence, psychiatric diagnosis, psychotropic medication, survivalAbstract
Objective: Falls are a significant health problem which affects quality of life in the elderly. This study was undertaken to study mortality and prevalence of falls, and their associations with psychiatric diagnoses and psychotropic medications.
Methods: The study was a retrospective 10-year data analysis of a general hospital database from 2006-2015. Prevalence, odds ratio, hazard ratio, and survival analysis were analyzed to study the association.
Results: The overall prevalence of falls was 3.6%. Subjects with psychiatric diagnoses were with 3.28 more chance of falls. Subjects with psychotropic medication prescriptions were with 1.76 more chance of falls. Survival analysis revealed mean survival of 6.84 years after falls. The average survival years after falls was age related. Subjects with history of falls and carrying psychiatric diagnoses were with mean survival of 6.55 years and the hazard ratio of 0.84. Subjects with history of falls and psychotropic medication prescriptions were with means survival 6.15 years and the hazard ratio of 1.27.
Conclusion: Psychiatric diagnoses and psychotropic medication prescriptions were associated with falls. Subjects with history of psychotropic medication prescriptions were associated with higher risk of mortality.
References
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25. Kim DH, Brown RT, Ding EL, Kiel DP, Berry SD. Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J Am Geriatr Soc. 2011;59:1019-31.
26. van Strien AM, Koek HL, van Marum RJ, Emmelot-Vonk MH. Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly. Maturitas. 2013;74:357-62.
27. Blachman NL, Leipzig RM, Mazumdar M, Poeran J. High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing?. J Am Geriatr Soc. 2017;65:603-7.
28. Sterke CS, van Beeck EF, van der Velde N, Ziere G, Petrovic M, Looman CW, et al. New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia. J Clin Pharmacol. 2012;52:947-55.
29. Pan HH, Li CY, Chen TJ, Su TP, Wang KY. Association of polypharmacy with fall-related fractures in older Taiwanese people: age- and gender-specific analyses. BMJ Open. 2014;4:e004428.
30. Hatch BB, Wood-Wentz CM, Therneau TM, Walker MG, Payne JM, Reeves RK. Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. Spinal Cord. 2017;55:540-4.
2. Sartini M, Cristina ML, Spagnolo AM, Cremonesi P, Costaguta C, Monacelli F, et al. The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden. Eur J Public Health. 2010;20:604-6.
3. Lach HW, Parsons JL. Impact of fear of falling in long term care: an integrative review. J Am Med Dir Assoc. 2013;14:573-7.
4. Hartholt KA, van Beeck EF, Polinder S, van der Velde N, van Lieshout EM, Panneman MJ, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma-Injury Infect Crit Care. 2011;71:748-53.
5. Department of Disease Control. Severe injury due to accidental falls. In: Palipatna T, editor. Annual epidemiological surveillance report 2015. Nonthaburi, Thailand: Department of Disease Control, Minister of Public Health; 2016. p. 193-6.
6. Hill KD, Wee R. Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem. Drugs Aging. 2012;29:15-30.
7. Heckenbach K, Ostermann T, Schad F, Kroz M, Matthes H. Medication and falls in elderly outpatients: an epidemiological study from a German Pharmacovigilance Network. SpringerPlus. 2014;3:483.
8. Bozat-Emre S, Doupe M, Kozyrskyj AL, Grymonpre R, Mahmud SM. Atypical antipsychotic drug use and falls among nursing home residents in Winnipeg, Canada. Int J Geriatr Psychiatr. 2015;30:842-50
9. Quach L, Yang FM, Berry SD, Newton E, Jones RN, Burr JA, et al. Depression, antidepressants, and falls among community-dwelling elderly people: the MOBILIZE Boston study. J Gerontol Ser A-Biol Sci Med Sci. 2013;68:1575-81.
10. Kallin K, Lundin-Olsson L, Jensen J, Nyberg L, Gustafson Y. Predisposing and precipitating factors for falls among older people in residential care. Public Health. 2002;116:263-71.
11. Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T. The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PloS One. 2015;10:e0116820.
12. Crump C, Sundquist K, Winkleby MA, Sundquist J. Mental disorders and risk of accidental death. Br J Psychiatry. 2013;203:297-302.
13. Kragh Ekstam A, Elmstahl S. Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study. Clin Interv Aging. 2016;11:489-96.
14. Johnell K, Jonasdottir Bergman G, Fastbom J, Danielsson B, Borg N, Salmi P. Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults. Int J Geriatr Psychiatry. 2017;32:414-20.
15. Bloch F, Thibaud M, Dugue B, Breque C, Rigaud AS, Kemoun G. Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J Aging Health. 2011;23:329-46.
16. Bloch F, Thibaud M, Tournoux-Facon C, Breque C, Rigaud AS, Dugue B, 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.
17. Griffin CE, 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13:214-23.
18. Robin DW, Hasan SS, Edeki T, Lichtenstein MJ, Shiavi RG, Wood AJ. Increased baseline sway contributes to increased losses of balance in older people following triazolam. J Am Geriatr Soc. 1996;44:300-4.
19. Passaro A, Volpato S, Romagnoni F, Manzoli N, Zuliani G, Fellin R. Benzodiazepines with different half-life and falling in a hospitalized population: The GIFA study. Gruppo Italiano di Farmacovigilanza nell'Anziano. J Clin Epidemiol. 2000;53:1222-9.
20. Kelly KD, Pickett W, Yiannakoulias N, Rowe BH, Schopflocher DP, Svenson L, et al. Medication use and falls in community-dwelling older persons. Age Ageing. 2003;32:503-9.
21. Buckley JS, Salpeter SR. A Risk-Benefit Assessment of Dementia Medications: Systematic Review of the Evidence. Drugs Aging. 2015;32:453-67.
22. Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp gerontol. 2003;38:843-53.
23. Crentsil V, Ricks MO, Xue QL, Fried LP. A pharmacoepidemiologic study of community-dwelling, disabled older women: Factors associated with medication use. Am J Geriatr Pharmacother. 2010;8:215-24.
24. Laflamme L, Monarrez-Espino J, Johnell K, Elling B, Moller J. Type, number or both? A population-based matched case-control study on the risk of fall injuries among older people and number of medications beyond fall-inducing drugs. PloS One. 2015;10:e0123390.
25. Kim DH, Brown RT, Ding EL, Kiel DP, Berry SD. Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J Am Geriatr Soc. 2011;59:1019-31.
26. van Strien AM, Koek HL, van Marum RJ, Emmelot-Vonk MH. Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly. Maturitas. 2013;74:357-62.
27. Blachman NL, Leipzig RM, Mazumdar M, Poeran J. High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing?. J Am Geriatr Soc. 2017;65:603-7.
28. Sterke CS, van Beeck EF, van der Velde N, Ziere G, Petrovic M, Looman CW, et al. New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia. J Clin Pharmacol. 2012;52:947-55.
29. Pan HH, Li CY, Chen TJ, Su TP, Wang KY. Association of polypharmacy with fall-related fractures in older Taiwanese people: age- and gender-specific analyses. BMJ Open. 2014;4:e004428.
30. Hatch BB, Wood-Wentz CM, Therneau TM, Walker MG, Payne JM, Reeves RK. Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. Spinal Cord. 2017;55:540-4.
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Published
07-05-2020
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Sitdhiraksa, N., Apiwannarat, N., Boonyaprapa, W., Sanguanpanich, N., Wansrisuthon, W., Chaiyawat, P., Ratta-Apha, W., Sirikunchoat, J., & Pariwatcharakul, P. (2020). Mortality and Prevalence of Falls, and their Association with Psychiatric Diagnoses and Psychotropic Medications . Siriraj Medical Journal, 72(5), 399–406. https://doi.org/10.33192/Smj.2020.54
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