Top

BMC Geriatrics

Published in:

Open Access 01-12-2024 | ß-Blockers | Research

Fall risk factors among poly-medicated older Lebanese patients in primary care settings: a secondary cross-sectional analysis of the “MGPIDP-L project”

Authors: Sarah El Khatib, Carmela Bou Malham, Sandrine Andrieu, Mathilde Strumia, Philippe Cestac, Pascale Salameh

Published in: BMC Geriatrics | Issue 1/2024

Abstract

Background

Falling is a major concern for the health of older adults and significantly affects their quality of life. Identifying the various risk factors and the differences between older patients can be challenging. The objective of this study was to identify the risk factors for falls among polymedicated community-dwelling older Lebanese patients following a medication review.

Methods

In this analytical cross-sectional study, we examined the risk factors for falls in 850 patients aged ≥ 65 years who were taking ≥ 5 medications daily. The study involved conducting a medication review over the course of a year in primary care settings and using multivariate logistic regression analysis to analyze the data.

Results

Our results showed that 106 (19.5%) of the 850 included patients had fallen at least once in the three months prior to the medication review. Loss of appetite and functional dependence were identified as the most significant predictors of falls ORa = 3.020, CI [2.074–4.397] and ORa = 2.877, CI [1.787–4.632], respectively. Other risk factors for falls included drowsiness ORa = 2.172, CI [1.499–3.145], and the use of beta-blockers ORa = 1.943, CI [1.339–2.820].

Conclusion

Our study highlights the importance of addressing multiple risk factors for falls among Lebanese older adults and emphasizes the need for customized interventions and ongoing monitoring to prevent falls and improve health outcomes. This study sheds light on a critical issue in the Lebanese older population and provides valuable insight into the complex nature of falls among poly-medicated Lebanese community-dwelling older adults.

Trial registration

2021REC-001- INSPECT -09–04.

Qin Z, Baccaglini L. Distribution, determinants, and prevention of falls among the elderly in the 2011–2012 California health interview survey. Public Health Rep. 2016;131(2):331–9. https://doi.org/10.1177/003335491613100217.CrossRefPubMedPubMedCentral

United Nations, Department of Economic and Social Affairs, & Population Division. (2017). World population ageing: 2017 highlights. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf.

Salari N, Darvishi N, Ahmadipanah M, Shohaimi S, Mohammadi M. Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):334. https://doi.org/10.1186/s13018-022-03222-1.CrossRefPubMedPubMedCentral

Boulos C, Salameh P, Barberger-Gateau P. The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: Protocol and sample characteristics. BMC Public Health. 2013;13(1):573. https://doi.org/10.1186/1471-2458-13-573.CrossRefPubMedPubMedCentral

Almawlawi E, Al Ansari A, Ahmed A. (2011). Prevalence and Risk Factors for Falls Among the Elderly in Primary Healthcare Centers (PHC) in Qatar. Qatar Medical Journal, 2011(1). https://doi.org/10.5339/qmj.2011.1.7.

Assiri EH, Assiri MH, Alsaleem SA. Epidemiology of falls among elderly people attending primary healthcare centers in Abha City, Saudi Arabia. World Family Med J/Middle East J Family Med. 2020;18(2):47–59. https://doi.org/10.5742/MEWFM.2020.93766.CrossRef

Guidelines WF. (n.d.). World Falls Guidelines. World Falls Guidelines. Retrieved January 8, 2024, from https://worldfallsguidelines.com/.

Pluijm SMF, Smit JH, Tromp EAM, Stel VS, Deeg DJH, Bouter LM, Lips P. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporosis Int. 2006;17(3):417–25. https://doi.org/10.1007/s00198-005-0002-0.CrossRef

Zhang L, Ding Z, Qiu L, Li A. Falls and risk factors of falls for urban and rural community-dwelling older adults in China. BMC Geriatr. 2019;19(1):379. https://doi.org/10.1186/s12877-019-1391-9.CrossRefPubMedPubMedCentral

10.

World Health Organization, World Health Organization. Ageing and Life Course Unit, 2008. WHO global report on falls prevention in older age. World Health Organization. (n.d.).

11.

Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91. https://doi.org/10.1111/j.1532-5415.2007.01156.x.CrossRefPubMedPubMedCentral

12.

Smith EM, Shah AA. Screening for geriatric syndromes. Clin Geriatr Med. 2018;34(1):55–67. https://doi.org/10.1016/j.cger.2017.08.002.CrossRefPubMed

13.

Le K, Chou E, Boyce RD, Albert SM. Fall risk-increasing drugs, polypharmacy, and falls among low-income community-dwelling older adults. Innovation in Aging. 2021;5(1):igab001. https://doi.org/10.1093/geroni/igab001.CrossRef

14.

Bunn F, Dickinson A, Barnett-Page E, Mcinnes E, Horton K. A systematic review of older people’s perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing Soc. 2008;28(4):449–72. https://doi.org/10.1017/S0144686X07006861.CrossRef

15.

Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging. 2012;29(5):359–76. https://doi.org/10.2165/11599460-000000000-00000.CrossRefPubMed

16.

Chung JY. Geriatric clinical pharmacology and clinical trials in the elderly. Transl Clin Pharmacol. 2014;22(2):64–9. https://doi.org/10.12793/tcp.2014.22.2.64.CrossRef

17.

Tan JL, Eastment JG, Poudel A, Hubbard RE. Age-related changes in hepatic function: an update on implications for drug therapy. Drugs Aging. 2015;32(12):999–1008. https://doi.org/10.1007/s40266-015-0318-1.CrossRefPubMed

18.

Chen Y, Zhu L-L, Zhou Q. Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients. Ther Clin Risk Manag. 2014;10:437–48. https://doi.org/10.2147/TCRM.S63756.CrossRefPubMedPubMedCentral

19.

SciELO - Brazil—Chronic kidney disease and the aging population Chronic kidney disease and the aging population. (n.d.). Retrieved July 14, 2022, from https://www.scielo.br/j/jbn/a/Yh9RsTbnS3qcKTT5HJ7hLRF.

20.

Correa-Pérez A, Delgado-Silveira E, Martín-Aragón S, Cruz-Jentoft AJ. Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol. Therapeu Adv Drug Safety. 2019;10:204209861986864. https://doi.org/10.1177/2042098619868640.CrossRef

21.

de Vries M, Seppala LJ, Daams JG, Van de Glind EMM, Masud T, van der Velde N, Blain H, Bousquet J, Bucht G, Caballero-Mora MA, van der Cammen T, Eklund P, Emmelot-Vonk M, Gustafson Y, Hartikainen S, Kenny RA, Laflamme L, Landi F, Masud T, van der Velde N. Fall-risk-increasing drugs: a systematic review and meta-analysis: I. Cardiovascular drugs. J American Med Directors Assoc. 2018;19(4):371.e1-371.e9. https://doi.org/10.1016/j.jamda.2017.12.013.CrossRef

22.

Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink AMAT, van der Velde N, Blain H, Bousquet J, Bucht G, Caballero-Mora MA, van der Cammen T, Eklund P, Emmelot-Vonk M, Gustafson Y, Hartikainen S, Kenny RA, Laflamme L, Landi F, van der Velde N. Fall-risk-increasing drugs: a systematic review and meta-analysis: III. Others. J American Med Directors Assoc. 2018;19(4):372.e1-372.e8. https://doi.org/10.1016/j.jamda.2017.12.099.CrossRef

23.

Seppala LJ, Wermelink AMAT, de Vries M, Ploegmakers KJ, van de Glind EMM, Daams JG, van der Velde N, Blain H, Bousquet J, Bucht G, Caballero-Mora MA, van der Cammen T, Eklund P, Emmelot-Vonk M, Gustafson Y, Hartikainen S, Kenny RA, Laflamme L, Landi F, van der Velde N. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics. J American Med Directors Assoc. 2018;19(4):371.e11-371.e17. https://doi.org/10.1016/j.jamda.2017.12.098.CrossRef

24.

Fastbom J, Schmidt I. (n.d.). Indikatorer för god läkemedelsterapi hos äldre. The Swedish National Board of Health and Welfare, 106.

25.

Bou Malham C, El Khatib S, Cestac P, Andrieu S, Rouch L, Salameh P. Impact of pharmacist-led interventions on patient care in ambulatory care settings: a systematic review. Int J Clin Pract. 2021;75(11):e14864. https://doi.org/10.1111/ijcp.14864.CrossRefPubMed

26.

Ming Y, Zecevic AA, Hunter SW, Miao W, Tirona RG. Medication review in preventing older adults’ fall-related injury: a systematic review & meta-analysis. Canadian Geriatr J. 2021;24(3):237–50. https://doi.org/10.5770/cgj.24.478.CrossRef

27.

Lavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Therapeu Adv Drug Safety. 2016;7(1):11–22. https://doi.org/10.1177/2042098615615472.CrossRef

28.

Bou Malham C, El Khatib S, Cestac P, Andrieu S, Rouch L, Salameh P., C. (n.d.). Management of potentially inappropriate drug prescribing among Lebanese patients in primary care settings -the MGPIDP-L project: Description of an interventional prospective non-randomized study. PLOS ONE.

29.

Ismail RA, Sibai RHE, Dakessian AV, Bachir RH, Sayed MJE. Fall related injuries in elderly patients in a tertiary care centre in Beirut, Lebanon. J Emerg Trauma Shock. 2020;13(2):142. https://doi.org/10.4103/JETS.JETS_84_19.CrossRefPubMedPubMedCentral

30.

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(2):187–95. https://doi.org/10.1111/j.1365-2125.2006.02744.x.CrossRefPubMed

31.

Malham CB, Khatib SE, Strumia M, Andrieu S, Cestac P, Salameh P. The MGPIDP-L project: potentially inappropriate drug prescribing and its associated factors. Arch Gerontol Geriatr. 2023;109:104947. https://doi.org/10.1016/j.archger.2023.104947.CrossRefPubMed

32.

By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American geriatrics society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults: 2019 AGS beers criteria® update expert panel. J Am Geriatr Soc. 2019;67(4):674–94. https://doi.org/10.1111/jgs.15767.CrossRef

33.

Ml L, Jp C. (n.d.). Liste de médicaments potentiellement inappropriés à la pratique médicale française. 11.

34.

Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: A list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861–75. https://doi.org/10.1007/s00228-015-1860-9.CrossRefPubMedPubMedCentral

35.

Lavan AH, Gallagher P, Parsons C, O’Mahony D. STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): Consensus validation. Age Ageing. 2017;46(4):600–7. https://doi.org/10.1093/ageing/afx005.CrossRefPubMed

36.

O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2014;44(2):213–8. https://doi.org/10.1093/ageing/afu145.CrossRefPubMedPubMedCentral

37.

Lawlor DA. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ. 2003;327(7417):712–7. https://doi.org/10.1136/bmj.327.7417.712.CrossRefPubMedPubMedCentral

38.

Ziere G, Dieleman JP, Hofman A, Pols HAP, van der Cammen TJM, Stricker BHCh. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61(2):218–23. https://doi.org/10.1111/j.1365-2125.2005.02543.x.CrossRefPubMed

39.

Srinivasan R, Lohith CP, Srinivasan R, Lohith CP. Main study—detailed statistical analysis by multiple regression. Strategic marketing and innovation for Indian MSMEs. Singapore: Springer; 2017. p. 69–92.

40.

Vittinghoff et al. - Regression Methods in Biostatistics.pdf. (n.d.). Retrieved March 2, 2023, from https://cds.cern.ch/record/1499230/files/9781461413523_TOC.pdf.

41.

Frailty.net. (2016, February 23). A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: The FiND questionnaire. Frailty. https://frailty.net/frailty-toolkit/diagnostic-tools/a-self-reported-screening-tool-for-detecting-community-dwelling-older-persons-with-frailty-syndrome-in-the-absence-of-mobility-disability-the-find-questionnaire-2/.

42.

Esquivel MK. Nutritional assessment and intervention to prevent and treat malnutrition for fall risk reduction in elderly populations. Am J Lifestyle Med. 2018;12(2):107–12. https://doi.org/10.1177/1559827617742847.CrossRefPubMed

43.

Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, Bekkering GE, Duyck J. Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data. Adv Nutr. 2016;7(3):507. https://doi.org/10.3945/an.115.011254.CrossRefPubMedPubMedCentral

44.

Ülger Z, Halil M, Kalan I, Yavuz BB, Cankurtaran M, Güngör E, Arıoğul S. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clin Nutr. 2010;29(4):507–11. https://doi.org/10.1016/j.clnu.2010.01.006.CrossRefPubMed

45.

Weiss EP, Jordan RC, Frese EM, Albert SG, Villareal DT. Effects of weight loss on lean mass, strength, bone, and aerobic capacity. Med Sci Sports Exerc. 2017;49(1):206–17. https://doi.org/10.1249/MSS.0000000000001074.CrossRefPubMedPubMedCentral

46.

Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011;20(5):514–22. https://doi.org/10.1002/pds.2116.CrossRefPubMed

47.

Jyrkkä J, Mursu J, Enlund H, Lönnroos E. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. 2012;15(1):1–6. https://doi.org/10.1097/MCO.0b013e32834d155a.CrossRefPubMed

48.

Fabian E, Bogner M, Kickinger A, Wagner K-H, Elmadfa I. Intake of medication and vitamin status in the elderly. Ann Nutr Metab. 2011;58(2):118–25. https://doi.org/10.1159/000327351.CrossRefPubMed

49.

Rahi B, Daou T, Gereige N, Issa Y, Moawad Y, Zgheib K. Effects of polypharmacy on appetite and malnutrition risk among institutionalized lebanese older adults—preliminary results. Curr Dev Nutr. 2020;4(Supplement_2):69–69. https://doi.org/10.1093/cdn/nzaa040_069.CrossRefPubMedCentral

50.

Heuberger RA, Caudell K. Polypharmacy and nutritional status in older adults: a cross-sectional study. Drugs Aging. 2011;28(4):315–23. https://doi.org/10.2165/11587670-000000000-00000.CrossRefPubMed

51.

Douglass R, Heckman G. Drug-related taste disturbance: a contributing factor in geriatric syndromes. Canadian Family Physician Medecin De Famille Canadien. 2010;56(11):1142–7.PubMedPubMedCentral

52.

Doty RL, Shah M, Bromley SM. Drug-induced taste disorders. Drug Safety. 2008;31(3):199–215. https://doi.org/10.2165/00002018-200831030-00002.CrossRefPubMed

53.

Cesari M, Demougeot L, Boccalon H, Guyonnet S, Abellan Van Kan G, Vellas B, Andrieu S. A self-reported screening tool for detecting community-dwelling older persons with frailty syndrome in the absence of mobility disability: the FiND questionnaire. PLoS ONE. 2014;9(7):e101745. https://doi.org/10.1371/journal.pone.0101745.CrossRefPubMedPubMedCentral

54.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology. Series A Biolog Sci Med Sci. 2001;56(3):M146-156. https://doi.org/10.1093/gerona/56.3.m146.CrossRef

55.

Frailty in Older People. (2013). Lancet, 381(9868), 752–762. https://doi.org/10.1016/S0140-6736(12)62167-9.

56.

Cheng M-H, Chang S-F. Frailty as a risk factor for falls among community dwelling people: evidence from a meta-analysis: falls with frailty. J Nurs Scholarsh. 2017;49(5):529–36. https://doi.org/10.1111/jnu.12322.CrossRefPubMed

57.

Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatr Soc. 2000;48(10):1234–40. https://doi.org/10.1111/j.1532-5415.2000.tb02596.x.CrossRefPubMed

58.

Glab KL, Wooding FGG, Tuiskula KA. Medication-related falls in the elderly: mechanisms and prevention strategies. Consult Pharm. 2014;29(6):5.CrossRef

59.

Chang C-H, Yang Y-HK, Lin S-J, Su J-J, Cheng C-L, Lin L-J. Risk of insomnia attributable to β-blockers in elderly patients with newly diagnosed hypertension. Drug Metab Pharmacokinet. 2013;28(1):53–8. https://doi.org/10.2133/dmpk.dmpk-12-rg-004.CrossRefPubMed

60.

Doghramji PP. Detection of insomnia in primary care. J Clin Psychiatry. 2001;62(Suppl 10):18–26.PubMed

61.

CV Drugs That Negatively Affect Sleep Quality. (n.d.). American College of Cardiology. Retrieved January 16, 2022, from https://www.acc.org/latest-in-cardiology/articles/2014/07/18/15/46/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2014%2f07%2f18%2f15%2f46%2fcv-drugs-that-negatively-affect-sleep-quality.

62.

Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60. https://doi.org/10.1001/archinternmed.2009.357.CrossRefPubMed

63.

Zang G. Antihypertensive drugs and the risk of fall injuries: a systematic review and meta-analysis. J Int Med Res. 2013;41(5):1408–17. https://doi.org/10.1177/0300060513497562.CrossRefPubMed

64.

Ham AC, van Dijk SC, Swart KMA, Enneman AW, van der Zwaluw NL, Brouwer-Brolsma EM, van Schoor NM, Zillikens MC, Lips P, de Groot LCPGM, Hofman A, Witkamp RF, Uitterlinden AG, Stricker BH, van der Velde N. Beta-blocker use and fall risk in older individuals: original results from two studies with meta-analysis: beta-blocker use and fall risk in older people. Br J Clin Pharmacol. 2017;83(10):2292–302. https://doi.org/10.1111/bcp.13328.CrossRefPubMedPubMedCentral

65.

Lee J, Negm A, Peters R, Wong EKC, Holbrook A. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open. 2021;11(2):e035978. https://doi.org/10.1136/bmjopen-2019-035978.CrossRefPubMedPubMedCentral

66.

Ageing and health. (n.d.). Retrieved July 12, 2022, from https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.

67.

Ungar A, Rafanelli M, Iacomelli I, Brunetti MA, Ceccofiglio A, Tesi F, Marchionni N. Fall prevention in the elderly. Clin Cases Miner Bone Metab. 2013;10(2):91–5.PubMedPubMedCentral

68.

Phelan EA, Mahoney JE, Voit JC, Stevens JA. Assessment and management of fall risk in primary care settings. Med Clin North Am. 2015;99(2):281–93. https://doi.org/10.1016/j.mcna.2014.11.004.CrossRefPubMedPubMedCentral

Title: Fall risk factors among poly-medicated older Lebanese patients in primary care settings: a secondary cross-sectional analysis of the “MGPIDP-L project”
Authors: Sarah El Khatib
Carmela Bou Malham
Sandrine Andrieu
Mathilde Strumia
Philippe Cestac
Pascale Salameh
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: ß-Blockers
Published in: BMC Geriatrics / Issue 1/2024
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-024-04951-0

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2024

The prevalence and impact of sarcopenia in older cardiac patients undergoing inpatient cardiac rehabilitation – results from a prospective, observational cohort pre-study

Frailty predicts all-cause and cause-specific mortality among older adults in Austria: 8-year mortality follow-up of the Austrian Health Interview Survey (ATHIS 2014)

Item distribution, internal consistency and structural validity of the German language person-centred climate questionnaire - staff version (PCQ-G-S): a cross-sectional study

Interaction between visual impairment and subjective cognitive complaints on physical activity impairment in U.S. older adults: NHANES 2005–2008

IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study

Physical frailty intensifies the positive association of oral frailty with poor global cognitive function and executive function among older adults especially for females: a cross-sectional study

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials