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Marciniak D, Alexander NB, Hoffman GJ. Physical Activity and Falls Among a National Cohort of Older Veterans. J Appl Gerontol 2020; 40:310-319. [PMID: 32274955 DOI: 10.1177/0733464820915807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The more than 20 million U.S. veterans have a history of physical activity engagement but face increasing disability as they age. Falls are common among older adults, but there is little evidence on veterans' fall risk. We conducted a retrospective cohort study using 48,643 observations from 14,831 older (≥65 years) Americans from the 2006-2014 waves of the Health and Retirement Study. Veterans reported more noninjurious falls (26.6% vs. 24.0%, p < .002), but fewer fall-related injuries (8.9% vs. 12.3%, p < .001) than nonveterans. In adjusted analyses, for each 5-year increase in age, the odds of a noninjurious fall were greater for veterans (odds ratio [OR] = 1.05, 95% confidence interval [CI] = [1.01, 1.10]) and, among those with regular physical activity, the odds were lower for veterans compared with nonveterans (OR = 0.89; 95% CI = [0.81, 0.99]). For veterans, physical activity engagement may prove a particularly effective mechanism for reducing the aging-related risks associated with falls and fall injuries.
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Affiliation(s)
| | - Neil B Alexander
- University of Michigan, Ann Arbor, USA.,VA Medical Center, Ann Arbor, MI, USA
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Watt JA, Gomes T, Bronskill SE, Huang A, Austin PC, Ho JM, Straus SE. Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study. CMAJ 2019; 190:E1376-E1383. [PMID: 30478215 DOI: 10.1503/cmaj.180551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Trazodone is increasingly prescribed for behavioural and psychological symptoms of dementia, but little is known about its risk of harm. Our objective was to describe the comparative risk of falls and fractures among older adults with dementia dispensed trazodone or atypical antipsychotics. METHODS The study cohort included adults with dementia (excluding patients with chronic psychotic illnesses) living in long-term care and aged 66 years and older. Data were obtained from routinely collected, linked health administrative databases in Ontario, Canada. We compared new users of trazodone with new users of atypical antipsychotics (quetiapine, olanzapine or risperidone) between Dec. 1, 2009, and Dec. 31, 2015. The primary outcome was a composite of fall or major osteoporotic fracture within 90 days of first prescription. Secondary outcomes were falls, major osteoporotic fractures, hip fractures and all-cause mortality. RESULTS We included 6588 older adults dispensed trazodone and 2875 dispensed an atypical antipsychotic, of whom 95.2% received a low dose of these medications. Compared with use of atypical antipsychotics, use of trazodone was associated with similar rates of falls or major osteoporotic fractures (weighted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.73 to 1.07), major osteoporotic fracture (weighted HR 1.03, 95% CI 0.73 to 1.47), falls (weighted HR 0.91, 95% CI 0.75 to 1.11) and hip fractures (weighted HR 0.92, 95% CI 0.59 to 1.43). Use of trazodone was associated with a lower rate of mortality (weighted HR 0.75, 95% CI 0.66 to 0.85). INTERPRETATION Trazodone is not a uniformly safer alternative to atypical antipsychotics, given the similar risk of falls and fractures among older adults with dementia.
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Affiliation(s)
- Jennifer A Watt
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Tara Gomes
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Susan E Bronskill
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Anjie Huang
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Peter C Austin
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Joanne M Ho
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont
| | - Sharon E Straus
- Division of Geriatric Medicine (Watt, Straus), University of Toronto; Li Ka Shing Knowledge Institute (Watt, Gomes, Straus), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto; ICES Central (Bronskill, Huang, Austin); Institute of Health Policy, Management, and Evaluation (Bronskill, Austin), University of Toronto, Toronto Ont.; ICES McMaster (Ho); Department of Medicine (Ho), McMaster University, Hamilton, Ont.
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Perng HJ, Chiu YL, Chung CH, Kao S, Chien WC. Fall and risk factors for veterans and non-veterans inpatients over the age of 65 years: 14 years of long-term data analysis. BMJ Open 2019; 9:e030650. [PMID: 31481377 PMCID: PMC6731917 DOI: 10.1136/bmjopen-2019-030650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Falls are one of the most important causes of injuries and accidental deaths among this segment of over the age of 65 years.The long-term follow-up study of fall-related injuries was conducted in elderly veterans over the age of 65 years, and the risk of falls in veterans and non-veterans was compared. METHODS This study used the National Health Insurance Research Database for the period from 2000 to 2013 in Taiwan. This longitudinal study tracked falls in veterans over the age of 65 years, designated a control group (non-veterans), using 1:2 pairing on the basis of sex and time receiving medical care, and used Cox regression to analyse and compare the risk of falls among veterans and non-veterans. RESULTS This study subjects consisted of 35 454 of the veterans had suffered falls (9.5%), as had 55 037 of the non-veterans (7.4%). After controlling for factors such as comorbidities/complications, the veterans had 1.252 times the risk of falls of the non-veterans. Furthermore, among persons in the 75-84 years old age group, veterans had 1.313 times the risk of falls of non-veterans, and among persons with mental illnesses and diseases of the eyes, veterans had 1.300 and 1.362 times the risk of falls of non-veterans. In addition, each veteran had an average of 4.07 falls during the 2000-2013 period, which was significantly higher than in the case of non-veterans (3.88 falls). CONCLUSIONS Veterans' risk of falls and recurrent falls were both higher than those of non-veterans, and age level, comorbidities/complications and level of low urbanisation were all important factors affecting veterans' falls. The responsible authorities should, therefore, use appropriate protective measures to reduce the risk of falls and medical expenses in high-risk groups.
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Affiliation(s)
- Huey-Jen Perng
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital Taipei, National Defense Medical Center, Taipei, Taiwan
| | - Senyeong Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital Taipei, National Defense Medical Center, Taipei, Taiwan
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Luther SL, McCart JA, Berndt DJ, Hahm B, Finch D, Jarman J, Foulis PR, Lapcevic WA, Campbell RR, Shorr RI, Valencia KM, Powell-Cope G. Improving identification of fall-related injuries in ambulatory care using statistical text mining. Am J Public Health 2015; 105:1168-73. [PMID: 25880936 DOI: 10.2105/ajph.2014.302440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined whether statistical text mining (STM) can identify fall-related injuries in electronic health record (EHR) documents and the impact on STM models of training on documents from a single or multiple facilities. METHODS We obtained fiscal year 2007 records for Veterans Health Administration (VHA) ambulatory care clinics in the southeastern United States and Puerto Rico, resulting in a total of 26 010 documents for 1652 veterans treated for fall-related injury and 1341 matched controls. We used the results of an STM model to predict fall-related injuries at the visit and patient levels and compared them with a reference standard based on chart review. RESULTS STM models based on training data from a single facility resulted in accuracy of 87.5% and 87.1%, F-measure of 87.0% and 90.9%, sensitivity of 92.1% and 94.1%, and specificity of 83.6% and 77.8% at the visit and patient levels, respectively. Results from training data from multiple facilities were almost identical. CONCLUSIONS STM has the potential to improve identification of fall-related injuries in the VHA, providing a model for wider application in the evolving national EHR system.
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Affiliation(s)
- Stephen L Luther
- Stephen L. Luther, James A. McCart, Bridget Hahm, Dezon Finch, Philip R. Foulis, William A. Lapcevic, Robert R. Campbell, and Gail Powell-Cope are with the HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL. Donald J. Berndt is with the University of South Florida College of Business Administration, Tampa. Jay Jarman is with the East Tennessee State University Department of Computing, Johnson City. Ronald I. Shorr is with the North Florida/South Georgia Veterans Health System, Gainesville, FL. Keryl Motta Valencia is with the VA Caribbean Healthcare System, San Juan, PR
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Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of falls on initiation of antihypertensive drugs in the elderly. Osteoporos Int 2013; 24:2649-57. [PMID: 23612794 DOI: 10.1007/s00198-013-2369-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/05/2013] [Indexed: 02/06/2023]
Abstract
SUMMARY Antihypertensive drugs are associated with an immediate increased falls risk in elderly patients which was significant during the first 14 days after receiving a thiazide diuretic, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker, or beta-adrenergic blocker. Fall prevention strategies during this period may prevent fall-related injuries. INTRODUCTION The purpose of this study is to evaluate if initiation of the common antihypertensive drugs is associated with the occurrence of falls. METHODS This population-based self-controlled case series study used healthcare administrative databases to identify new users of antihypertensive drugs in the elderly aged 66 and older living in Ontario, Canada who suffered a fall from April 1, 2000 to March 31, 2009. The risk period was the first 45 days following antihypertensive therapy initiation, further subdivided into 0-14 and 15-44 days with control periods before and after treatment in a 450-day observation period. We calculated the relative incidence (incidence rate ratio, IRR), defined as the rate of falls in the risk period compared to falls rate in the control periods. RESULTS Of the 543,572 new users of antihypertensive drugs among community-dwelling elderly, 8,893 experienced an injurious fall that required hospital care during the observation period. New users had a 69 % increased risk of having an injurious fall during the first 45 days following antihypertensive treatment (IRR = 1.69; 95 % CI, 1.57-1.81). This finding was consistent for thiazide diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers but not angiotensin II receptor antagonists. There was also an increased falls risk during the first 14 days of antihypertensive drug initiation (IRR = 1.94; 95 % CI, 1.75-2.16), which was consistent for all antihypertensive drug classes. CONCLUSIONS This study suggests that initiation of antihypertensive drugs is a risk factor for falls in the elderly. Fall prevention strategies during this period may reduce injuries.
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Affiliation(s)
- D A Butt
- Department of Family and Community Medicine, The Scarborough Hospital, University of Toronto, Toronto, Ontario, Canada,
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Identifying fall-related injuries: Text mining the electronic medical record. INFORMATION TECHNOLOGY & MANAGEMENT 2009. [DOI: 10.1007/s10799-009-0061-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Formiga F, Lopez-Soto A, Duaso E, Ruiz D, Chivite D, Perez-Castejon JM, Navarro M, Pujol R. Characteristics of fall-related hip fractures in community-dwelling elderly patients according to cognitive status. Aging Clin Exp Res 2008; 20:434-8. [PMID: 19039285 DOI: 10.1007/bf03325149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Falls are a major cause of morbidity and mortality in older people who have cognitive impairment. The present study compared the characteristics of community-dwelling patients, with and without previous diagnosis of dementia, hospitalized because of a hip fracture. METHODS 1024 consecutive patients >65 years (77.2% women, mean age 82.9 yrs) admitted for fall-related hip fracture to six Spanish hospitals during a 20-month period were included. Sociodemographic data, geriatric assessment and characteristics (location, time and possible cause: intrinsic, extrinsic or combined risk factor) of falls leading to hip fracture were evaluated. RESULTS A total of 154 (15%) patients had a previous diagnosis of dementia. Analysis showed a greater number of previous falls before admission for hip fracture in demented patients. Moreover, in non-demented patients, we found both a predominance of falls during the day and of extrinsic factors. CONCLUSION Some differences were observed, according to the cognitive status of elderly patients suffering a hip fracture due to a fall. A high percentage of dementia patients had suffered repeated falls prior to the fall-related hip fracture.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ. Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc 2007; 56:705-10. [PMID: 18005354 DOI: 10.1111/j.1532-5415.2007.01479.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To estimate the risk and long-term prognostic significance of 30-day readmission postdischarge of a 4-year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for comorbidities. DESIGN Retrospective, national secondary data analysis. SETTING National Medicare and Veterans Health Administration (VHA) facilities. PARTICIPANTS The study cohort was 41,331 veterans with a HFx first admitted to a Medicare eligible facility during 1999 to 2002. MEASUREMENTS HFxs were linked with all other Medicare and VHA inpatient discharge files to capture dual inpatient use. Logistic regression was used to examine the relationship between 30-day readmission and age, sex, inpatient length of stay, and selected Elixhauser comorbidities. RESULTS Approximately 18.3% (7,579/41,331) of HFx patients were readmitted within 30 days. Of those with 30-day readmissions, 48.5% (3,675/7,579) died within 1 year, compared with 24.9% (8,388/33,752) of those without 30-day readmissions. Readmission risk was significantly greater in the presence of specific comorbidities, ranging from 11% greater risk for patients with fluid and electrolyte disorders (95% confidence interval (CI)=1.04-1.20) to 43% for renal failure (95% CI=1.29-1.60). For this cohort, cardiac arrhythmias (24%), chronic pulmonary disease (28%), and congestive heart failure (16%) were common comorbidities, and all affected the risk of 30-day readmission. CONCLUSION Patients with HFx with 30-day readmissions were nearly twice as likely to die within 1 year. Identification of several predictive comorbidities at discharge and examination of reasons for subsequent readmission suggests that readmission was largely due to active comorbid clinical problems. These comorbidity findings have implications for the current Centers for Medicare and Medicaid Services (CMS) pay-for-performance initiatives, especially those related to better coordination of care for patients with chronic illnesses. These comorbidity findings for elderly patients with HFx may also provide data to enable CMS and healthcare providers to more accurately differentiate between comorbidities and hospital-acquired complications under the current CMS initiative related to nonpayment for certain types of medical conditions and hospital acquired infections.
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Affiliation(s)
- Dustin D French
- Veterans Integrated Service Network-8 Patient Safety Center of Inquiry, James A. Haley Veterans Affairs Medical Center, Tampa, Florida 33612, USA.
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Chang WC, Kaul P, Westerhout CM, Graham MM, Armstrong PW. Effects of socioeconomic status on mortality after acute myocardial infarction. Am J Med 2007; 120:33-9. [PMID: 17208077 DOI: 10.1016/j.amjmed.2006.05.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Revised: 05/23/2006] [Accepted: 05/27/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess the effects of socioeconomic status on mortality in patients with acute myocardial infarction. MATERIAL AND METHODS We studied a retrospective cohort of 5622 patients who presented to a hospital emergency department with an initial episode of acute myocardial infarction between April 1998 and March 2002 in the Province of Alberta, Canada. Our main outcome measure was 1-year all-cause mortality following the index emergency department visit; we used socioeconomic status (measured by neighborhood median household income) as our main predictor after controlling for patient and hospital characteristics and revascularization. RESULTS Socioeconomic status profoundly affected the rate of emergency department presentation and the process and outcome of acute myocardial infarction care. In patients belonging to the lowest versus the highest socioeconomic status quartile, the risk of presenting to the emergency department was 72% higher (P <.001); at 1 year, revascularization was lower (36% vs 48%, P <.001), and mortality higher (19.1% vs 9.1%, P <.001). Socioeconomic status was independently associated with 1-year mortality after adjustment for baseline characteristics and 1-year revascularization, and socioeconomic status was especially influential in non-revascularized patients. CONCLUSIONS Given the influence of socioeconomic status on mortality after acute myocardial infarction and the key role of revascularization in modulating this relationship, our study has important implications for access to and process of cardiac care.
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French DD, Campbell R, Spehar A, Rubenstein LZ, Branch LG, Cunningham F. National outpatient medication profiling: medications associated with outpatient fractures in community-dwelling elderly veterans. Br J Clin Pharmacol 2006; 63:238-44. [PMID: 17096682 PMCID: PMC2000572 DOI: 10.1111/j.1365-2125.2006.02798.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS The primary objective of this retrospective case-control study in an elderly veteran population was to assess the impact of specific medications with recognized side-effects that increase the risk of a fall and were prescribed prior to fractures treated in the outpatient setting compared with patients treated for nonspecific chest pain. METHODS Two national Veterans Health Administration (VHA) databases were used to identify 17 273 unique patients, aged > or =65 years, treated in outpatient settings with a fracture in fiscal year 2005, and for whom we could link to all of their outpatient prescriptions (809 536). For comparison, we identified other elderly patients with outpatient clinic visits for nonspecific chest pain (N = 62 331) for whom we could link with their 2 987 394 outpatient prescriptions. We categorized the fall-related medications as drugs that primarily affect the cardiovascular (CVS), the central nervous (CNS) or the muscular skeletal system (MSS). RESULTS Significant differences in the two patient groups occurred in the CNS category. Approximately 41% of the patients with fracture-coded encounters were prescribed CNS drugs compared with 31% of the patients in the comparison group (P < 0.0003). Finally, the use of muscle relaxants in the MSS category was significantly higher in the fracture group than in the nonspecific chest pain group. CONCLUSIONS Studies using administrative data can foster the development of more proactive pharmacovigilance systems and assist in formulary refinement, particularly in countries with national healthcare systems that have integrated patient data. Particular attention and monitoring of elderly patients taking CNS medications may be important for injury prevention.
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Affiliation(s)
- Dustin D French
- VISN-8 Patient Safety Center of Inquiry, James A. Haley Hospital, Tampa, FL 33612, USA.
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French DD, Campbell R, Spehar A, Cunningham F, Bulat T, Luther SL. Drugs and falls in community-dwelling older people: a national veterans study. Clin Ther 2006; 28:619-30. [PMID: 16750473 DOI: 10.1016/j.clinthera.2006.04.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to identify which specific medications within recognized major problematic drug categories that increase risk of falling were prescribed to veterans before their out-patient treatment for a fall. METHODS This was a retrospective, cross-sectional national secondary outpatient data analysis with an age- and sex-matched comparison group. The setting was the national Veterans Health Administration (VHA) ambulatory health care system in fiscal year (FY) 2004. The study population was VHA patients aged>or=65 years who had fall-related outpatient clinical health care encounters in FY 2004 (as indicated by diagnostic codes) and who received >or=1 outpatient medication during the study period. The age- and sex-matched comparison group consisted of an equal number of patients with nonspecific chest pain. The percentage of patients in each group receiving medications (at the time of the outpatient encounter) that affect the cardiovascular system (CVS), central nervous system (CNS), or musculoskeletal system (MSS) was compared with Bonferrom-adjusted P values. RESULTS The study sample consisted of 20,551 patients; the comparison group included the same number of patients. More patients with fall-coded encounters used CNS drugs than those with nonspecific chest pain (42.05% vs 29.29%). Also, within the CNS category, more patients with fall-coded encounters used antiparkinsonian medications (3.67% vs 1.32%), Alzheimer's disease medications (ie, cholinesterase inhibitors [5.40% vs 2.35%]), anticonvulsants/barbiturates (8.95% vs 5.18%), antidepressants (22.50% vs 14.16%), antipsychotics (4.68% vs 2.01%), opioid analgesics and narcotics (11.21% vs 9.09%), and benzodiazepines (7.60% vs 5.96%) (all, P<0.002). More patients with nonspecific chest pain received CVS drugs compared with the fall-coded group (69.13% vs 63.07%; P<0.002). Within the CVS category, more patients in the nonspecific chest pain group received angiotensin-II receptor antagonists, angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, vasodilators, diuretics, and antiarrhythmics (all, P<0.002). No differences were noted between groups in the MSS category, except for NSAIDs, which more patients in the nonspecific chest pain group used than in the fall-coded group (6.44% vs 5.63%; P<0.002). CONCLUSION In this study, subjects with a health care encounter for a fall (as indicated by diagnostic code) were prescribed significantly more CNS-category medications than subjects in the age- and sex-matched comparison group.
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Affiliation(s)
- Dustin D French
- Patient Safety Center, Veterans Integrated System Network 8, James A. Haley Hospital, and University of South Florida College of Public Health, Tampa, Florida 33612, USA.
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