Fall Risk-Increasing Drugs, Polypharmacy, and Falls Among Low-Income Community-Dwelling Older Adults.
Fall Risk-Increasing Drugs, Polypharmacy, and Falls Among Low-Income Community-Dwelling Older Adults.
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DOI：
10.1093/geroni/igab001
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发表时间：
2021
影响因子：
7
通讯作者：
Albert SM
中科院分区：
文献类型：
--
作者：
Ie K;Chou E;Boyce RD;Albert SM
药物暴露是老年人跌倒、随后死亡和功能下降的潜在危险因素。然而，关于评估药物暴露的最佳方法以及哪种方法最能预测跌倒，仍存在争议。目前这项研究的目的是检查社区老年人中不同的药物暴露措施与跌倒风险之间的联系。这项回顾性队列研究使用了无瀑布宾夕法尼亚州计划数据和宾夕法尼亚州老年人药物援助合同中的相关处方药索赔数据。参与者是居住在美国宾夕法尼亚州的社区老年人。评估了药物暴露的三个衡量标准：(A)常规药物的总数(多药)；(B)从当前处方指导工具得出的潜在不适当药物的计数(增加跌倒风险的药物[FRID]，Beers标准)；以及(C)基于药理机制的药物负担指数(抗胆碱能认知负担，药物负担指数)，所有这些都来自索赔数据。用单变量和多变量负二项回归模型检验不同用药风险指标与自述跌倒发生率之间的关系，以估计发生率比(IRR)。总体而言，343名老年人被纳入其中，在2316个活动调整的人月中有236个月跌倒(每100个活动调整的人月中有10.2个跌倒)。在多变量模型中评估的6个用药风险指标中，只有使用2个或2个以上的FRID(调整后的IRR为1.67[95%CI：1.04-2.68])独立预测跌倒风险。在13种FRID药物类别中，唯一与跌倒风险增加相关的FRID类别是抗抑郁药。处方中存在多个FRID是跌倒的独立危险因素，即使在药物很少的老年人中也是如此。还需要进一步的调查，以检查以FRID为重点的停药是否有效预防这一人群中的跌倒。
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.
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影响因子：
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作者：
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通讯作者：
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