1
|
Kanis E, Gallegos P, Christman K, Vazquez D, Mullen C, Cucci MD. Impact of medication intensification on 30-day hospital readmissions in a geriatric trauma population: A multicenter cohort study. Pharmacotherapy 2024; 44:39-48. [PMID: 37926857 DOI: 10.1002/phar.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Fall-related injuries are a significant health issue that occur in 25% of older adults and account for a significant number of trauma-related hospitalizations. Although medication intensification may increase the risk of hospital readmissions in non-trauma patients, data on a geriatric trauma population are lacking. OBJECTIVE The primary objective was to evaluate the effect of medication intensification on 30-day hospital readmissions in geriatric patients hospitalized for fall-related injuries. METHODS This multicenter, retrospective cohort study included patients with geriatric who presented to one of three trauma centers within a large, health-system between January 1, 2018 and December 31, 2020. Patients at least 65 years old admitted with a fall-related injury were eligible for inclusion. Patients were grouped according to medication changes at discharge, which included intensified and non-intensified groups. Medication intensification included increased dose(s) or initiation of new agents. The primary outcome was the 30-day hospital readmission rate. RESULTS Of the 870 patients included (median [interquartile range, IQR] age, 82 [74-89] years, 522 (60%) female, and 220 (25%) with a previous fall), there were 471 (54%) and 399 (46%) patients in the intensified and non-intensified groups, respectively. The intensified group had a higher 30-day hospital readmission rate (21% intensified vs. 16% non-intensified, p = 0.043; number needed to harm 20) based on an unweighted analysis. According to a weighted propensity score logistic regression, medication intensification was associated with higher 30-day hospital readmissions (24% [95% confidence interval [CI] 19-31%] intensified vs. 15% [95% CI 11-20%] non-intensified, p = 0.018). These results were consistent within competing risk models accounting for death (cause-specific model: hazard ratio [HR] 1.63 [95% CI 1.07-2.49], p = 0.023; Fine-Gray model: HR 1.64 [95% CI 1.07-2.50], p = 0.022). CONCLUSIONS In a geriatric trauma population hospitalized after a fall, intensification of medications may pose an increased risk of 30-day hospital readmission.
Collapse
Affiliation(s)
- Emily Kanis
- Department of Pharmacy, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Patrick Gallegos
- Department of Pharmacy, Cleveland Clinic Akron General, Akron, Ohio, USA
- Department of Pharmacy Practice, Department of Internal Medicine, Northeast Ohio Medical Center, Rootstown, Ohio, USA
| | - Kailey Christman
- Department of Research, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Daniel Vazquez
- Department of Surgery, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Chanda Mullen
- Department of Research, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Michaelia D Cucci
- Department of Pharmacy, Cleveland Clinic Akron General, Akron, Ohio, USA
| |
Collapse
|
2
|
Yuan K, Haddad Y, Law R, Shakya I, Haileyesus T, Navon L, Zhang L, Liu Y, Bergen G. Emergency Department Visits for Alcohol-Associated Falls Among Older Adults in the United States, 2011 to 2020. Ann Emerg Med 2023; 82:666-677. [PMID: 37204348 PMCID: PMC10950308 DOI: 10.1016/j.annemergmed.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
STUDY OBJECTIVE The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States. METHODS We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults. RESULTS There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups. CONCLUSION Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk.
Collapse
Affiliation(s)
- Keming Yuan
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Yara Haddad
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Royal Law
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Iju Shakya
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Tadesse Haileyesus
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Livia Navon
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lei Zhang
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yang Liu
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gwen Bergen
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
3
|
Haddad YK, Kakara R, Marcum ZA. A comparative analysis of selective serotonin reuptake inhibitors and fall risk in older adults. J Am Geriatr Soc 2022; 70:1450-1460. [PMID: 35132611 PMCID: PMC9106871 DOI: 10.1111/jgs.17686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/10/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND One in five older adults (age 65+) uses an antidepressant medication. However, little is known about how fall risk differs between commonly prescribed medications. We examine the comparative association between individual selective serotonin reuptake inhibitors (SSRI) and self-reported falls in older adults. METHODS We used data from 2010-2017 Medicare Current Beneficiary Surveys, a nationally representative survey of Medicare beneficiaries. We included participants from three different panels surveyed over two successive years. Participants were limited to community-dwelling Medicare beneficiaries 65+, enrolled in Medicare Part D, and taking an SSRI (n = 1023) during baseline years. Participants were asked about demographic and health characteristics, medication use (including dose, frequency, duration of use) and self-reported falls as any fall or recurrent falls in the past year. We compared individual SSRI (citalopram or escitalopram vs sertraline) use by the average monthly total standardized daily dose (TSDD) and self-reported falling, controlling for potential confounders. Descriptive analysis and multivariable logistic regressions were conducted using SAS-callable SUDAAN. RESULTS Citalopram/escitalopram (n = 460 users; 45.0% of all SSRI users) and sertraline (n = 294 users; 28.7% of all SSRI users) were the most commonly prescribed SSRIs. Overall, 36.3% of citalopram/escitalopram users and 39.4% of sertraline users reported a fall in the year following medication use. There were no statistically significant differences between sertraline and citalopram/escitalopram users of either low or medium TSDD levels in the risk of self-reported any or recurrent falls. However, users of high TSDD of sertraline (>75 mg) had a lower risk of recurrent falls compared to high TSDD citalopram (>30 mg) or escitalopram (>15 mg) daily for 30 days. CONCLUSION These findings suggest a potential comparative safety benefit of sertraline compared to citalopram/escitalopram at high doses related to recurrent falls. Additional comparative studies of individual antidepressants may better inform fall risk management and prescribing for older adults.
Collapse
Affiliation(s)
- Yara K Haddad
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ramakrishna Kakara
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Cherokee Nation Operational Solutions, LLC, Atlanta, Georgia, USA
| | - Zachary A Marcum
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
Gray SL, Elsisi Z, Phelan EA, Hanlon JT. Interventions to Reduce Fall-Risk-Increasing Drug Use to Prevent Falls: A Narrative Review of Randomized Trials. Drugs Aging 2021; 38:301-309. [PMID: 33543411 DOI: 10.1007/s40266-021-00835-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Falls and fall-related injuries are of growing concern among older adults. Use of fall-risk-increasing drugs (FRIDs) is a potentially modifiable risk factor. This narrative review describes randomized controlled trials that focused on interventions to reduce FRID use and examined fall-related outcomes (e.g., falls, fractures, risk of injury) as the primary outcome. METHODS A comprehensive literature search was conducted to identify eligible studies. Two reviewers screened titles and abstracts and then performed a full-text review of relevant articles. Each study is summarized, and a discussion of strengths and limitations is provided. RESULTS 7 of 22 trials were included in this narrative review. Two studies used a computerized decision support intervention, three used a health professional-led (pharmacist or geriatrician) intervention, and two were direct medication withdrawal interventions. Three studies showed a reduction in fall-related outcomes (two identified fall injuries using claims data; one used an injury risk prediction score). Of these, only one reported FRID reduction. Of four studies that did not find a reduction in falls, one study reported a significant reduction in FRIDs, two found no reduction, and one did not report on this outcome. Most interventions consisted of a one-time FRID assessment, and most targeted either providers or patients (not both). CONCLUSION Most interventions did not reduce FRID use or change fall-related outcomes. Future studies should test "multi-pronged" intervention strategies that simultaneously target both patients and their providers and include more than a single intervention interaction to reduce this modifiable fall risk factor.
Collapse
Affiliation(s)
- Shelly L Gray
- Department of Pharmacy, School of Pharmacy, University of Washington, Health Sciences Building, H-361D, Box 357630, Seattle, Washington, 98195-7630, USA.
| | - Zizi Elsisi
- Department of Pharmacy, School of Pharmacy, University of Washington, Health Sciences Building, H-361D, Box 357630, Seattle, Washington, 98195-7630, USA
| | - Elizabeth A Phelan
- Department of Medicine (Geriatrics), School of Medicine, University of Washington, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Joseph T Hanlon
- Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Education, and Clinical Center, Geriatric Research, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| |
Collapse
|
5
|
Haddad YK, Luo F, Bergen G, Legha JK, Atherly A. Special Report from the CDC Antidepressant subclass use and fall risk in community-dwelling older Americans. JOURNAL OF SAFETY RESEARCH 2021; 76:332-340. [PMID: 33653566 PMCID: PMC8139010 DOI: 10.1016/j.jsr.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Falls among older adults are a significant health concern affecting more than a quarter of older adults (age 65+). Certain fall risk factors, such as medication use, increase fall risk among older adults (age 65+). AIM The aim of this study is to examine the association between antidepressant-medication subclass use and self-reported falls in community-dwelling older adults. METHODS This analysis used the 2009-2013 Medicare Current Beneficiary Survey, a nationally representative panel survey. A total of 8,742 community-dwelling older adults, representing 40,639,884 older Medicare beneficiaries, were included. We compared self-reported falls and psychoactive medication use, including antidepressant subclasses. These data are controlled for demographic, functional, and health characteristics associated with increased fall risk. Descriptive analyses and multivariate logistic regression analyses were conducted using SAS 9.4 and Stata 15 software. RESULTS The most commonly used antidepressant subclass were selective serotonin reuptake inhibitors (SSRI) antidepressants (13.1%). After controlling for characteristics associated with increased fall risk (including depression and concurrent psychoactive medication use), the risk of falling among older adults increased by approximately 30% among those who used a SSRI or a serotonin-norepinephrine reuptake inhibitors (SNRI) compared to non-users. The adjusted risk ratio (aRR) for SSRI was 1.29 (95% CI = 1.13, 1.47) and for SNRI was 1.32 (95% CI = 1.07, 1.62). CONCLUSION SSRI and SNRI are associated with increased risk of falling after adjusting for important confounders. Medication use is a modifiable fall risk factor in older adults and can be targeted to reduce risk of falls. Practical Applications: Use of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors increased the risk of falling in older adults by approximately 30%, even after controlling for demographic, functional, and health characteristics, including depression. Health care providers can work towards reducing fall risk among their older patients by minimizing the use of certain medications when potential risks outweigh the benefits.
Collapse
Affiliation(s)
- Yara K Haddad
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Feijun Luo
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gwen Bergen
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jaswinder K Legha
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam Atherly
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| |
Collapse
|