Top

Drugs & Aging

Published in:

01-09-2017 | Original Research Article

Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture

Authors: Andrea Iaboni, Kerri Rawson, Craig Burkett, Eric J. Lenze, Alastair J. Flint

Published in: Drugs & Aging | Issue 9/2017

Abstract

Background

Older adults after hip fracture are at increased risk of being prescribed potentially inappropriate medications, and may be particularly vulnerable to their adverse effects.

Objective

The objective of this study was to examine the association of potentially inappropriate medication use with the time to full functional recovery within 1 year of hip fracture repair.

Methods

We conducted a secondary analysis of a prospective longitudinal study of eight hospitals in St. Louis, MO, USA. The participants were older adults (n = 477) aged 60 years or older who had undergone surgical repair of a hip fracture free of delirium, dementia or depression at baseline. Drugs at baseline were categorised using the American Geriatrics Society 2012 Beers criteria. The outcome was the Functional Recovery Scale total score measured at four time points during a 12-month period of observation. Cox proportional hazards models examined the time to 95% recovery of function (‘full recovery’), adjusting for demographics, cognition, depression, medical co-morbidity, pre-fracture functioning and pain as covariates.

Results

Potentially inappropriate medication use was common following hip fracture, with 51% of participants prescribed at least one potentially inappropriate medication and 17.4% prescribed two or more potentially inappropriate medications. Potentially inappropriate medication use was significantly associated with a longer time to achieve full recovery with a hazard ratio of 0.69 (95% confidence interval 0.52–0.92; p = 0.012) and this association was stronger for two or more potentially inappropriate medications compared with one potentially inappropriate medication (hazard ratio = 0.60; 95% confidence interval 0.40–0.90; p = 0.014).

Conclusion

Potentially inappropriate medication use was associated with a longer time to full functional recovery in older adults who underwent surgery for a hip fracture, particularly in those using two or more potentially inappropriate medications at baseline.

Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170(10):1290–9.CrossRefPubMedPubMedCentral

Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380–90.CrossRefPubMedPubMedCentral

Boonen S, Autier P, Barette M, et al. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int. 2004;15(2):87–94.CrossRefPubMed

Bertram M, Norman R, Kemp L, et al. Review of the long-term disability associated with hip fractures. Inj Prev. 2011;17(6):365–70.CrossRefPubMed

Guralnik JM, Ferrucci L, Simonsick EM, et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556–61.CrossRefPubMed

Hallberg I, Bachrach-Lindström M, Hammerby S, et al. Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study. BMC Musculoskelet Disord. 2009;10:135.CrossRefPubMedPubMedCentral

Lloyd BD, Williamson DA, Singh NA, et al. Recurrent and injurious falls in the year following hip fracture: a prospective study of incidence and risk factors from the Sarcopenia and Hip Fracture study. J Gerontol A Biol Sci Med Sci. 2009;64(5):599–609.CrossRefPubMed

Lee HB, Mears SC, Rosenberg PB, et al. Predisposing factors for postoperative delirium after hip fracture repair in individuals with and without dementia. J Am Geriatr Soc. 2011;59(12):2306–13.CrossRefPubMedPubMedCentral

Mangoni AA, van Munster BC, Woodman RJ, et al. Measures of anticholinergic drug exposure, serum anticholinergic activity, and all-cause postdischarge mortality in older hospitalized patients with hip fractures. Am J Geriatr Psychiatry. 2013;21(8):785–93.CrossRefPubMed

10.

Gosch M, Wortz M, Nicholas JA, et al. Inappropriate prescribing as a predictor for long-term mortality after hip fracture. Gerontology. 2014;60(2):114–22.CrossRefPubMed

11.

Iaboni A, Fischer HD, Diong C, et al. Initiation of antidepressant medication after hip fracture in community-dwelling elderly. Am J Geriatr Psychiatry. 2015;23(10):1007–15.CrossRefPubMed

12.

Cristancho P, Lenze EJ, Avidan MS, et al. Trajectories of depressive symptoms after hip fracture. Psychol Med. 2016;46(7):1413–25.CrossRefPubMedPubMedCentral

13.

Rawson KS, Dixon D, Nowotny P, et al. Association of functional polymorphisms from brain-derived neurotrophic factor and serotonin-related genes with depressive symptoms after a medical stressor in older adults. PLoS One. 2015;10(3):e0120685.CrossRefPubMedPubMedCentral

14.

First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders (SCID-I), Clinician Version, administration booklet. Washington DC: American Psychiatric Association; 2012.

15.

Fick D, Semla T, Beizer J, et al. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.CrossRef

16.

Zuckerman JD, Koval KJ, Aharonoff GB, et al. A functional recovery score for elderly hip fracture patients: I. Development. J Orthop Trauma. 2000;14(1):20–5.CrossRefPubMed

17.

Munin MC, Seligman K, Dew MA, et al. Effect of rehabilitation site on functional recovery after hip fracture. Arch Phys Med Rehabil. 2005;86(3):367–72.CrossRefPubMed

18.

Montgomery SA, Asberg M. New depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–9.CrossRefPubMed

19.

Tosato M, Landi F, Martone AM, et al. Potentially inappropriate drug use among hospitalised older adults: results from the CRIME study. Age Ageing. 2014;43(6):767–73.CrossRefPubMed

20.

Davidoff AJ, Miller GE, Sarpong EM, et al. Prevalence of potentially inappropriate medication use in older adults using the 2012 Beers criteria. J Am Geriatr Soc. 2015;63(3):486–500.CrossRefPubMedPubMedCentral

21.

Munson JC, Bynum JW, Bell J, et al. Patterns of prescription drug use before and after fragility fracture. JAMA Intern Med. 2016;176(10):1531–8.CrossRefPubMed

22.

Koshoedo S, Soiza RL, Purkayastha R, et al. Anticholinergic drugs and functional outcomes in older patients undergoing orthopaedic rehabilitation. Am J Geriatr Pharmacother. 2012;10(4):251–7.CrossRefPubMed

23.

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.CrossRefPubMedPubMedCentral

24.

Gallagher P, Lang PO, Cherubini A, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.CrossRefPubMed

25.

Feng L, Scherer SC, Tan BY, et al. Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation. Int Psychogeriatr. 2010;22(2):246–53.CrossRefPubMed

26.

Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc. 2008;56(6):1075–9.CrossRefPubMed

27.

Morrison RS, Magaziner J, McLaughlin MA, et al. The impact of post-operative pain on outcomes following hip fracture. Pain. 2003;103(3):303–11.CrossRefPubMed

28.

Zuckerman IH, Langenberg P, Baumgarten M, et al. Inappropriate drug use and risk of transition to nursing homes among community-dwelling older adults. Med Care. 2006;44(8):722–30.CrossRefPubMedPubMedCentral

29.

Hanlon JT, Fillenbaum GG, Kuchibhatla M, et al. Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Med Care. 2002;40(2):166–76.CrossRefPubMed

30.

Cooper JA, Cadogan CA, Patterson SM, et al. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015;5(12):e009235.CrossRefPubMedPubMedCentral

31.

Kragh A, Elmstahl S, Atroshi I. Older adults’ medication use 6 months before and after hip fracture: a population-based cohort study. J Am Geriatr Soc. 2011;59(5):863–8.CrossRefPubMed

32.

Walsh KA, O’Riordan D, Kearney PM, et al. Improving the appropriateness of prescribing in older patients: a systematic review and meta-analysis of pharmacists’ interventions in secondary care. Age Ageing. 2016;45(2):201–9.CrossRefPubMed

Title: Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture
Authors: Andrea Iaboni
Kerri Rawson
Craig Burkett
Eric J. Lenze
Alastair J. Flint
Publication date: 01-09-2017
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 9/2017
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-017-0482-6

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Potentially Inappropriate Medications and the Time to Full Functional Recovery After Hip Fracture

Abstract

Background

Objective

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2017

Cutaneous Drug Reactions in the Elderly

Trends in Drug Prescription Rates for Dementia: An Observational Population-Based Study in France, 2006–2014

Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation

Perioperative Care of Elderly Surgical Outpatients

Managing Idiopathic Pulmonary Fibrosis: Which Drug for Which Patient?

Risk of Mortality Associated with Anticholinergic Use in Elderly Nursing Home Residents with Depression

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page