Fall Risk-Increasing Drugs, Polypharmacy, and Falls Among Low-Income Community-Dwelling Older Adults
Open Access
- 1 January 2021
- journal article
- research article
- Published by Oxford University Press (OUP) in Innovation in Aging
- Vol. 5 (1), igab001
- https://doi.org/10.1093/geroni/igab001
Abstract
Medication exposure is a potential risk factor for falls and subsequent death and functional decline among older adults. However, controversy remains on the best way to assess medication exposure and which approach best predicts falls. The objective of the current study was to examine the association between different measures of medication exposure and falls risk among community-dwelling older adults. This retrospective cohort study was conducted using Falls Free PA program data and a linked prescription claims data from Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly program. Participants were community-dwelling older adults living in Pennsylvania, United States. Three measures of medication exposure were assessed: (a) total number of regular medications (polypharmacy); (b) counts of potentially inappropriate medications derived from current prescription guidance tools (Fall Risk-Increasing Drugs [FRIDs], Beers Criteria); and (c) medication burden indices based on pharmacologic mechanisms (Anticholinergic Cognitive Burden, Drug Burden Index) all derived from claims data. The associations between the different medication risk measures and self-reported falls incidence were examined with univariate and multivariable negative binomial regression models to estimate incidence rate ratios (IRRs). Overall 343 older adults were included and there were 236 months with falls during 2,316 activity-adjusted person-months (10.2 falls per 100 activity-adjusted person-months). Of the 6 measures of medication risk assessed in multivariate models, only the use of 2 or more FRIDs (adjusted IRR 1.67 [95% CI: 1.04–2.68]) independently predicted falls risk. Among the 13 FRID drug classes, the only FRID class associated with an increased fall risk was antidepressants. The presence of multiple FRIDs in a prescription is an independent risk factor for falls, even in older adults with few medications. Further investigation is required to examine whether deprescribing focused on FRIDs effectively prevents falls among this population.Funding Information
- Centers for Disease Control and Prevention (DP002657)
- Prevention Research Centers Program
- National Institute on Aging (K01 AG044433)
- U.S. National Library of Medicine (R01 LM011838)
- National Institutes of Health (AG024827)
- Pittsburgh Older Americans Independence Center
This publication has 38 references indexed in Scilit:
- Associations Between Drug Burden Index and Falls in Older People in Residential Aged CareJournal of the American Geriatrics Society, 2011
- Error in Table 3 in: Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly PersonsArchives of Internal Medicine, 2010
- Drug Burden Index Score and Functional Decline in Older PeopleThe American Journal of Medicine, 2009
- Drug Burden Index and physical function in older Australian menBritish Journal of Clinical Pharmacology, 2009
- A Drug Burden Index to Define the Functional Burden of Medications in Older PeopleArchives of Internal Medicine, 2007
- Older persons afraid of falling reduce physical activity to prevent outdoor fallsPreventive Medicine, 2007
- Fatalities and Injuries From Falls Among Older Adults—United States, 1993-2003 and 2001-2005JAMA, 2007
- Polypharmacy and falls in the middle age and elderly populationBritish Journal of Clinical Pharmacology, 2005
- The Relationship Between Number of Medications and Weight Loss or Impaired Balance in Older AdultsJournal of the American Geriatrics Society, 2004
- EuroQol - a new facility for the measurement of health-related quality of lifeHealth Policy, 1990