Different Risk-Increasing Drugs in Recurrent versus Single Fallers: Are Recurrent Fallers a Distinct Population?
Different Risk-Increasing Drugs in Recurrent versus Single Fallers: Are Recurrent Fallers a Distinct Population?
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DOI：
10.1007/s40266-013-0110-z
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发表时间：
2013-10-01
期刊：
影响因子：
2.8
通讯作者：
Abu-Hanna, Ameen
中科院分区：
文献类型：
--
作者：
Askari, Marjan;Eslami, Saied;Abu-Hanna, Ameen
背景 多重用药，特别是使用多种增加跌倒风险的药物 (FRID)，与老年人跌倒风险增加有关。然而，目前尚不清楚已知的 FRID 组是否可以外推到经常跌倒的人，因为他们形成了一个由具有不同特征的更脆弱的老年人组成的独特群体。目标我们的目的是调查哪些类别的药物与跌倒后到急诊科 (ED) 就诊的老年患者反复跌倒有关。方法本研究采用横断面设计，在学术医疗中心的 ED 中进行。邀请 65 岁或以上、在 2004 年至 2010 年期间到急诊科就诊的跌倒患者填写一份经过验证的跌倒调查问卷，旨在评估患者和跌倒特征（CAREFALL Triage Instrument [CTI]）。我们将自我报告的药物翻译为解剖治疗化学 (ATC) 代码（第二级）。进行单变量逻辑回归分析以探讨药物类别与结果参数（复发性跌倒）之间的关联。在调整潜在混杂因素后，使用多变量逻辑回归来评估相关性。 结果 共有 2,258 名患者参与了我们的研究，其中 39% (873) 在前一年内经历过两次或两次以上跌倒。调整潜在混杂因素后，治疗酸相关疾病的药物（调整后比值比 [aOR] 1.29；95% CI 1.03-1.60）、止痛药（aOR 1.22；95% CI 1.06-1.41）、抗帕金森药物（aOR 1.59；95% CI 1.02-2.46）、鼻用制剂（aOR 1.49；95% CI 1.07-2.08），眼科（aOR 1.51；95% CI 1.10-2.09）；抗精神病药（aOR 2.21；95% CI 1.08-4.52）和抗抑郁药（aOR 1.64；95% CI 1.13-2.37）与因反复跌倒而就诊的急诊室就诊之间保持统计学显着相关性。 结论 已知的 FRID，例如精神药物，也会增加反复跌倒的风险。然而，我们发现四个相对较新的类别与反复跌倒有显着关联。在某种程度上，这些类别可能作为虚弱和合并症的标志，或者它们可能反映了影响老年人、体弱人群的风险因素的差异，这些人群往往会反复跌倒。需要进一步调查以阐明原因和防止再次跌倒的方法。
Background Polypharmacy, and specifically the use of multiple fall-risk-increasing drugs (FRID), have been associated with increased risk of falling in older age. However, it is not yet clear whether the known set of FRIDs can be extrapolated to recurrent fallers, since they form a distinct group of more vulnerable older persons with different characteristics.Objectives We aim to investigate which classes of medications are associated with recurrent falls in elderly patients visiting the Emergency Department (ED) after a fall.Methods This study had a cross-sectional design and was conducted in the ED of an academic medical center. Patients who sustained a fall, 65 years or older, and who visited the ED between 2004 and 2010 were invited to fill in a validated fall questionnaire designed to assess patient and fall characteristics (CAREFALL Triage Instrument [CTI]). We translated self-reported medications to anatomical therapeutic chemical (ATC) codes (at the second level). Univariate logistic regression analysis was performed to explore the association between medication classes and the outcome parameter (recurrent fall). Multivariate logistic regression was used to assess the associations after adjustment to potential confounders.Results In total 2,258 patients participated in our study, of whom 39 % (873) had sustained two or more falls within the previous year. After adjustment for the potential confounders, drugs for acid-related disorders (adjusted odds ratio [aOR] 1.29; 95 % CI 1.03-1.60), analgesics (aOR 1.22; 95 % CI 1.06-1.41), anti-Parkinson drugs (aOR 1.59; 95 % CI 1.02-2.46), nasal preparations (aOR 1.49; 95 % CI 1.07-2.08), ophthalmologicals (aOR 1.51; 95 % CI 1.10-2.09); antipsychotics (aOR 2.21; 95 % CI 1.08-4.52), and antidepressants (aOR 1.64; 95 % CI 1.13-2.37) remained statistically significantly associated with an ED visit due to a recurrent fall.Conclusions Known FRIDs, such as psychotropic drugs, also increase the risk of recurrent falls. However, we found four relatively new classes that showed significant association with recurrent falls. In part, these classes may act as markers of frailty and comorbidity, or they may reflect differences in the risk factors affecting the older, frailer population that tends to sustain recurrent falls. Further investigation is needed to elucidate causes and ways to prevent recurrent falls.