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Published in: BMC Geriatrics 1/2020

Open Access 01-12-2020 | Research article

Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Authors: Charlotte Uggerhøj Andersen, Pernille Overgaard Lassen, Hussain Qassim Usman, Nadja Albertsen, Lars Peter Nielsen, Stig Andersen

Published in: BMC Geriatrics | Issue 1/2020

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Abstract

Background

Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people.
We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture.

Methods

We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons’ Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient.

Results

FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM.

Conclusions

The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.
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Literature
1.
go back to reference Hansen L, Mathiesen AS, Vestergaard P, Ehlers LH, Petersen KD. A health economic analysis of osteoporotic fractures: who carries the burden? Arch Osteoporos. 2013;8:126.CrossRef Hansen L, Mathiesen AS, Vestergaard P, Ehlers LH, Petersen KD. A health economic analysis of osteoporotic fractures: who carries the burden? Arch Osteoporos. 2013;8:126.CrossRef
2.
go back to reference Menendez-Colino R, Alarcon T, Gotor P, Queipo R, Ramirez-Martin R, Otero A, et al. Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA cohort). Injury. 2018;49:656–61.CrossRef Menendez-Colino R, Alarcon T, Gotor P, Queipo R, Ramirez-Martin R, Otero A, et al. Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA cohort). Injury. 2018;49:656–61.CrossRef
3.
go back to reference Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–90.CrossRef Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380–90.CrossRef
4.
go back to reference Zia A, Kamaruzzaman SB, Tan MP. The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls. Geriatr Gerontol Int. 2017;17:463–70.CrossRef Zia A, Kamaruzzaman SB, Tan MP. The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls. Geriatr Gerontol Int. 2017;17:463–70.CrossRef
5.
go back to reference 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.CrossRef 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.CrossRef
6.
go back to reference De Vries M, Seppala LJ, Daams JG, van de Glind EMM, Masud T, van der Velde N, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs. J Am Med Dir Assoc. 2018;19:371 e1–9.CrossRef De Vries M, Seppala LJ, Daams JG, van de Glind EMM, Masud T, van der Velde N, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs. J Am Med Dir Assoc. 2018;19:371 e1–9.CrossRef
7.
go back to reference Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink A, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others. J Am Med Dir Assoc. 2018;19:372 e1–8.CrossRef Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink A, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others. J Am Med Dir Assoc. 2018;19:372 e1–8.CrossRef
8.
go back to reference Seppala LJ, Wermelink A, de Vries M, Ploegmakers KJ, van de Glind EMM, Daams JG, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc. 2018;19:371 e11–7.CrossRef Seppala LJ, Wermelink A, de Vries M, Ploegmakers KJ, van de Glind EMM, Daams JG, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc. 2018;19:371 e11–7.CrossRef
9.
go back to reference Boye ND, van der Velde N, de Vries OJ, van Lieshout EM, Hartholt KA, Mattace-Raso FU, et al. Effectiveness of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial. Age Ageing. 2017;46:142–6.PubMed Boye ND, van der Velde N, de Vries OJ, van Lieshout EM, Hartholt KA, Mattace-Raso FU, et al. Effectiveness of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of FALLs (IMPROveFALL) trial. Age Ageing. 2017;46:142–6.PubMed
10.
go back to reference Beunza-Sola M, Hidalgo-Ovejero AM, Marti-Ayerdi J, Sanchez-Hernandez JG, Menendez-Garcia M, Garcia-Mata S. Study of fall risk-increasing drugs in elderly patients before and after a bone fracture. Postgrad Med J. 2018;94:76–80.CrossRef Beunza-Sola M, Hidalgo-Ovejero AM, Marti-Ayerdi J, Sanchez-Hernandez JG, Menendez-Garcia M, Garcia-Mata S. Study of fall risk-increasing drugs in elderly patients before and after a bone fracture. Postgrad Med J. 2018;94:76–80.CrossRef
11.
go back to reference Sjoberg C, Bladh L, Klintberg L, Mellstrom D, Ohlsson C, Wallerstedt SM. Treatment with fall-risk-increasing and fracture-preventing drugs before and after a hip fracture: an observational study. Drugs Aging. 2010;27:653–61.CrossRef Sjoberg C, Bladh L, Klintberg L, Mellstrom D, Ohlsson C, Wallerstedt SM. Treatment with fall-risk-increasing and fracture-preventing drugs before and after a hip fracture: an observational study. Drugs Aging. 2010;27:653–61.CrossRef
12.
go back to reference Lonnbro J, Wallerstedt SM. Clinical relevance of the STOPP/START criteria in hip fracture patients. Eur J Clin Pharmacol. 2017;73:499–505.CrossRef Lonnbro J, Wallerstedt SM. Clinical relevance of the STOPP/START criteria in hip fracture patients. Eur J Clin Pharmacol. 2017;73:499–505.CrossRef
13.
go back to reference 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. 2015;44:213–8.CrossRef 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. 2015;44:213–8.CrossRef
14.
go back to reference Sjoberg C, Wallerstedt SM. Effects of medication reviews performed by a physician on treatment with fracture-preventing and fall-risk-increasing drugs in older adults with hip fracture-a randomized controlled study. J Am Geriatr Soc. 2013;61:1464–72.CrossRef Sjoberg C, Wallerstedt SM. Effects of medication reviews performed by a physician on treatment with fracture-preventing and fall-risk-increasing drugs in older adults with hip fracture-a randomized controlled study. J Am Geriatr Soc. 2013;61:1464–72.CrossRef
15.
go back to reference Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75:51–61.CrossRef Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75:51–61.CrossRef
16.
go back to reference Leavy B, Byberg L, Michaelsson K, Melhus H, Aberg AC. The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study. BMC Geriatr. 2015;15:40.CrossRef Leavy B, Byberg L, Michaelsson K, Melhus H, Aberg AC. The fall descriptions and health characteristics of older adults with hip fracture: a mixed methods study. BMC Geriatr. 2015;15:40.CrossRef
17.
go back to reference Hartholt KA, Boye ND, Van der Velde N, Van Lieshout EM, Polinder S, De Vries OJ, et al. [Cost] effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study). BMC Geriatr. 2011;11:48.CrossRef Hartholt KA, Boye ND, Van der Velde N, Van Lieshout EM, Polinder S, De Vries OJ, et al. [Cost] effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study). BMC Geriatr. 2011;11:48.CrossRef
18.
go back to reference Machado-Duque ME, Castano-Montoya JP, Medina-Morales DA, Castro-Rodriguez A, Gonzalez-Montoya A, Machado-Alba JE. Drugs with anticholinergic potential and risk of falls with hip fracture in the elderly patients: a case-control study. J Geriatr Psychiatry Neurol. 2018;31:63–9.CrossRef Machado-Duque ME, Castano-Montoya JP, Medina-Morales DA, Castro-Rodriguez A, Gonzalez-Montoya A, Machado-Alba JE. Drugs with anticholinergic potential and risk of falls with hip fracture in the elderly patients: a case-control study. J Geriatr Psychiatry Neurol. 2018;31:63–9.CrossRef
19.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.CrossRef Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.CrossRef
20.
go back to reference Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US preventive services task force. JAMA. 2018;319:1705–16.CrossRef Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US preventive services task force. JAMA. 2018;319:1705–16.CrossRef
21.
go back to reference 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;59:863–8.CrossRef 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;59:863–8.CrossRef
22.
go back to reference Xiao X, Xu Y, Wu Q. Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies. Osteoporos Int. 2018;29:1515–24.CrossRef Xiao X, Xu Y, Wu Q. Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies. Osteoporos Int. 2018;29:1515–24.CrossRef
23.
go back to reference Clemens KK, Ouedraogo A, Speechley M, Richard L, Thain J, Shariff SZ. Hip fractures in older adults in Ontario, Canada-monthly variation, insights, and implications. Can Geriatr J. 2019;22:148–64.CrossRef Clemens KK, Ouedraogo A, Speechley M, Richard L, Thain J, Shariff SZ. Hip fractures in older adults in Ontario, Canada-monthly variation, insights, and implications. Can Geriatr J. 2019;22:148–64.CrossRef
24.
go back to reference Boddaert J, Cohen-Bittan J, Khiami F, Le Manach Y, Raux M, Beinis JY, et al. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One. 2014;9:e83795.CrossRef Boddaert J, Cohen-Bittan J, Khiami F, Le Manach Y, Raux M, Beinis JY, et al. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One. 2014;9:e83795.CrossRef
25.
26.
go back to reference Frederiksen A, Abrahamsen B, Johansen PB, Sorensen HA. Danish, national cross-sectional observational study on the prevalence of prior major osteoporotic fractures in adults presenting with hip fracture-limitations and scope for fracture liaison services in prevention of hip fracture. Osteoporos Int. 2018;29:109–14.CrossRef Frederiksen A, Abrahamsen B, Johansen PB, Sorensen HA. Danish, national cross-sectional observational study on the prevalence of prior major osteoporotic fractures in adults presenting with hip fracture-limitations and scope for fracture liaison services in prevention of hip fracture. Osteoporos Int. 2018;29:109–14.CrossRef
Metadata
Title
Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study
Authors
Charlotte Uggerhøj Andersen
Pernille Overgaard Lassen
Hussain Qassim Usman
Nadja Albertsen
Lars Peter Nielsen
Stig Andersen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-01532-9

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