Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial
Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial
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DOI：
10.1093/ageing/afw161
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发表时间：
2017-01-01
期刊：
影响因子：
6.7
通讯作者：
van der Cammen, Tischa J. M.
中科院分区：
文献类型：
--
作者：
Boye, Nicole D. A.;van der Velde, Nathalie;van der Cammen, Tischa J. M.
目的：研究撤除增加跌倒风险药物（FRID）与“常规护理”对减少社区老年跌倒者跌倒福尔斯的影响。设计：随机多中心试验。参与者：612名因跌倒而就诊于急诊室（艾德）的老年人。干预措施：撤除FRID。主要结局和测量：主要结局是首次自我报告跌倒的时间。次要结局是至第二次自我报告跌倒的时间和至需要全科医生（GP）咨询或ED访视的福尔斯的时间。进行意向治疗（主要）和符合方案（次要）分析。使用Cox回归模型计算跌倒时间的风险比（HR）。在累积发病率的差异进行了分析，福尔斯使用Poisson regression.Results：在12个月的随访，91（34%）控制和115（37%）干预参与者经历了下降; 35%的所有尝试干预是不成功的，无论是由于复发的初始适应症处方，额外的药物治疗新诊断的条件或不遵守。与基线相比，干预组或对照组在12个月时≥ 3个FRID的使用者的总体百分比没有变化。我们的干预对首次跌倒时间（HR 1.17; 95%置信区间0.89-1.54）、第二次跌倒时间（1.19; 0.78-1.82）、首次跌倒相关GP咨询时间（0.66; 0.42-1.06）或首次跌倒相关ED访视时间（0.85; 0.43-1.68）没有显著影响。结论：在这个复杂的多病患者群体中，由于跌倒而就诊于艾德，我们的FRIDs-撤回的单一干预在减少跌倒方面是无效的。结论：在这个复杂的多病患者群体中，由于跌倒而就诊于艾德，我们的FRIDs-撤回的单一干预在减少福尔斯方面是无效的。
Objectives: to investigate the effect of withdrawal of fall-risk-increasing-drugs (FRIDs) versus 'care as usual' on reducing falls in community-dwelling older fallers.Design: randomised multicentre trial.Participants: six hundred and twelve older adults who visited an Emergency Department (ED) because of a fall.Interventions: withdrawal of FRIDs.Main Outcomes and Measures: primary outcome was time to the first self-reported fall. Secondary outcomes were time to the second self-reported fall and to falls requiring a general practitioner (GP)-consultation or ED-visit. Intention-to-treat (primary) and a per-protocol (secondary) analysis were conducted. The hazard ratios (HRs) for time-to-fall were calculated using a Cox-regression model. Differences in cumulative incidence of falls were analysed using Poisson regression.Results: during 12 months follow-up, 91 (34%) control and 115 (37%) intervention participants experienced a fall; 35% of all attempted interventions were unsuccessful, either due to recurrence of the initial indication for prescribing, additional medication for newly diagnosed conditions or non-compliance. Compared to baseline, the overall percentage of users of = 3 FRIDs at 12 months did not change in either the intervention or the control group. Our intervention did not have a significant effect on time to first fall (HR 1.17; 95% confidence interval 0.89-1.54), time to second fall (1.19; 0.78-1.82), time to first fall-related GP-consultation (0.66; 0.42-1.06) or time to first fall-related ED-visit (0.85; 0.43-1.68). Conclusion: in this population of complex multimorbid patients visiting an ED because of a fall, our single intervention of FRIDs-withdrawal was not effective in reducing falls.Conclusion: in this population of complex multimorbid patients visiting an ED because of a fall, our single intervention of FRIDs-withdrawal was not effective in reducing falls.