Medications and multiple falls in elderly people: the St Louis OASIS study

Toe grip force of the dominant foot is associated with fall risk in community-dwelling older adults: a cross-sectional study

Background

It is unclear whether the toe grip force (TGF) of the dominant foot (DF) and the lower limb function asymmetry (LLFA) in older adults are associated with fall risk. Therefore, this study aimed to investigate the effect of lower limb properties (such as TGF, muscle strength, and plantar sensation) on the risk of falls in older adults, while considering the foot dominance and asymmetry of lower limb function.

Methods

This study was a cross-sectional study. We determined whether the lower limb function of the DF and non-dominant foot (non-DF) and LLFA had any effect on the fall risk in 54 older adults (mean ± standard deviation: 72.2 ± 6.0, range: 60–87 years). We examined the participants’ fall history, Mini-Mental State Examination (MMSE) score, lower limb function, and LLFA. To determine fall risk factors, we performed logistic regression analysis, with presence or absence of falls as the dependent variable.

Results

The independent variables were age, sex, MMSE score, two-point discrimination of the heel (non-DF) as plantar sensation index, and the TGF of both feet. Only the TGF of the DF was identified as a risk factor for falls (p < 0.05).

Conclusions

In older adults, clinicians should focus on the TGF of the DF as a risk factor for falls.

Trial registration

This study was retrospectively registered. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_up_rec_f1.cgi.

Research on Beers Criteria and STOPP/START Criteria based on the FDA FAERS database

PURPOSE

Inappropriate medication criteria for the elderly have played an important role in ensuring the safety of medications for the elderly. Too few drugs included in the criteria cannot guarantee the safety of medication for the elderly. Too many drugs included in the criteria will result in less selective medication for the elderly. This paper uses real-world data to evaluate the relationship between antihypertensive drugs and falls, so as to provide references for experts and scholars to revise the criteria of potentially inappropriate medications for the elderly and clinical safe medication.

METHOD

We use the US Food and Drug Administration Adverse Event Reporting System (FDA FAERS) to evaluate the association between specific antihypertensive drugs in six categories (alpha-1 receptor blockers (α-1 blockers), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-receptor blockers (β-blockers), and diuretics) and falls by data mining algorithms, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), Medicines and Healthcare Products Regulatory Agency (MHRA), and the empirical Bayes geometric mean (EBGM) and compared with the relevant drugs included in the Beers Criteria and STOPP/START Criteria.

RESULT

There are a total of 5,157,172 co-occurrences found in 973,447 reports aged 65 years or older from 2016 to 2019 in the FDA FAERS database, and the number of co-occurrences of falls is 5917 for the six categories of 51 antihypertensive drugs. Four kinds of mining methods overlap detection of 12 kinds of positive signal drugs, none of which are not included in the Beers Criteria and 7 drugs are included in the STOPP/START Criteria; 1-3 kinds of mining methods overlap detection of positive signal drugs, a total of 12 kinds, and one drug is included in the Beers Criteria and 5 drugs are included in the STOPP/START Criteria; 22 drugs have fall adverse events, but no positive signal is detected, and 13 drugs are included in STOPP/START Criteria; and 5 drugs have no fall adverse events and 3 drugs are included in the STOPP/START Criteria.

CONCLUSION

The FAERS database was used to confirm the potential connection between some antihypertensive drugs and fall adverse events through data mining algorithms. The Beers Criteria did not clearly indicate the antihypertensive drugs that caused falls, and the antihypertensive drugs included in the STOPP/START Criteria were too extensive and did not include β-blockers and diuretics. It is recommended that experts and scholars use real-world data (such as FAERS, EudraVigilance, WHO VigiBase, and so on) to further explore the relationship between specific antihypertensive drugs and falls in the elderly, so as to revise and improve the criteria for inappropriate medications for the elderly.

Evaluation of Risk Factors for Falls in Patients with Rheumatoid Arthritis

Background

The aim of our study was to investigate the risk factors for falls in the rheumatoid arthritis (RA) patient population in Poland. This would be a major step towards the development of new fall prevention programs.

Material/Methods

There were 450 RA patients who met the criteria of the American College of Rheumatology who participated in this study. The average age of patient participants was 54.2 years; the average RA duration was 15.1 years. All patients filled out the study questionnaire regarding falls, medications, and diseases, and they filled out the Polish version of the Health Assessment Questionnaire (HAQ).

Results

Of the 400 patients, 203 patients (51%) experienced falls. Out of the 268 falls experienced by study patients, 113 falls (42%) were due to an environmental cause, the remainder 155 falls were caused by health conditions. The number of falls positively correlated with HAQ scores (r=0.42, P<0.01) and the duration of RA (r=0.39, P<0.05). For individuals who had fallen 3 or more times, there was a stronger positive correlation between the number of falls and the total HAQ score (r=0.61, P<0.01). The main risk factors for falls in the study group were dizziness (odds ratio [OR]=3.42), the use of hypotensive medication (OR=2.82), foot deformities (OR=4.09), and a high HAQ score (OR=2.59). Other factors such as drug use (e.g., glucocorticoids), pain, and duration of RA were measured using a visual analogue scale, and were found not to have increased the risk for falls and fractures (P>0.05).

Conclusions

Knowledge about risk factors can help identify high-risk patients to help decrease their risk of falling, thus preventing fall-related injuries.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics

BACKGROUND AND OBJECTIVE

Falls are a major public health problem in older adults. Earlier studies showed that psychotropic medication use increases the risk of falls. The aim of this study is to update the current knowledge by providing a comprehensive systematic review and meta-analysis on psychotropic medication use and falls in older adults.

METHODS AND DESIGN

This study is a systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated psychotropics (antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses were performed using generic inverse variance method pooling unadjusted and adjusted odds ratio (OR) estimates separately.

RESULTS

In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses using adjusted data showed the following pooled ORs: antipsychotics 1.54 [95% confidence interval (CI) 1.28-1.85], antidepressants 1.57 (95% Cl 1.43-1.74), tricyclic antidepressants 1.41 (95% CI 1.07-1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85-2.20), benzodiazepines 1.42 (95%, CI 1.22-1.65), long-acting benzodiazepines 1.81 (95%, CI 1.05-3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04-1.56) Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and healthcare setting.

CONCLUSIONS

Antipsychotics, antidepressants, and benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Prescription bias could not be accounted for. Future studies need to address pharmacologic subgroups as fall risk may differ depending on specific medication properties. Precise and uniform classification of target medication (Anatomical Therapeutic Chemical Classification) is essential for valid comparisons between studies.

A Literature Review of Psychotropic Medications and Alcohol as Risk Factors for Falls in Community Dwelling Older Adults

Psychotropic medications and alcohol are potential risk factors for falls in older adults. However, there has been no appraisal of the literature on whether these medications, both singly and in combination with alcohol, are associated with falls in community dwelling older adults (those aged 60 years and older living independently without care). Four databases (PubMed, EMBASE, CINAHL and SCOPUS) and the grey literature (i.e. WHO, Public Health Agency of Canada) were searched using the following terms: benzodiazepine, anti-psychotics, anti-depressants, anti-epileptic, lithium, memantine, anti-hypertensives: drug or medication, aged or elderly or older adult or senior, accidental falls or falls or falling, and alcohol. Studies were included if (1) they were primary studies; (2) included community dwelling persons aged 60 years and older; (3) alcohol use was an independent variable; (4) studied medications of interest; (5) falls was the outcome variable; and (6) published in English. Articles published until July 2018 were included. The search yielded 29 studies. The findings show that both benzodiazepines and antidepressants (particularly SSRIs) are associated with fall risk while antipsychotics, anti-hypertensives, anti-epileptics and alcohol are not. No statements were made about lithium or memantine due to a lack of research studies. Future studies with adequate power to detect significant associations between psychotropic medications and falls are needed, especially among individual benzodiazepine and antidepressant medications.

Gait Disorders and Falls in the Elderly

Gait disorders in the elderly may be based on a neurologic deficit at multiples levels, or may be secondary to nonneurologic causes. The physiology and pathophysiology of gait problems are reviewed and bedside examination and investigative tools are discussed. The reader will have an excellent working knowledge of the subject and will know how to diagnose and treat gait disorders and falls.

Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others

BACKGROUND AND OBJECTIVE

The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications.

METHODS AND DESIGN

A systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately.

RESULTS

In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association).

CONCLUSION

Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.

Medications & Polypharmacy Influence on Recurrent Fallers in Community: a Systematic Review

The purpose of this systematic review is to summarize information about the impact different classes of medications and polypharmacy have on recurrent falls, defined as two or more falls in a 12-month period, in community-dwelling older adults. After adjustment for confounders such as age, gender, weight or depression symptoms, the reviewed studies suggested that older adults who use antidepressants, sedatives or hypnotics and anti-epileptics were more likely to experience recurrent falls than non-users. Polypharmacy (use of four or more prescription medications daily) caused 1.5-2 times higher possibility of recurrent falls in older adults. As a high-risk group, recurrent fallers require meaningful intervention. Medications are believed to be a modifiable risk factor in falls prevention; hence, special consideration should be taken to balance the benefit and harm in initiating, continuing or increasing certain classes of medications in elderly recurrent fallers.

Risk Factors for Traumatic Brain Injuries During Falls in Older Persons

OBJECTIVE

To identify risk factors for traumatic brain injuries (TBIs) during falls in older Taiwanese people.

PARTICIPANTS

Case patients consisted of 113 patients aged 60 years or older with a moderate/severe TBI due to a fall. Two control groups: (1) 339 older patients with a soft-tissue injury; and (2) 113 with a mild-TBI due to a fall. Proxies were required to provide information for a considerable number of patients.

DESIGN

Matched case-control study.

SETTINGS

The emergency departments of 3 general hospitals.

MEASURES

Sociodemographic, lifestyle behavior, chronic condition, medication use, functional abilities, and fall-related characteristics.

RESULTS

When patients with a soft-tissue injury were assigned to the control group, men were 2.06-fold more likely to have a moderate/severe TBI than women. Subjects who took antiarrhythmics within 4 hours of a fall were 2.59-fold more likely to have a moderate/severe TBI than those who took none. Subjects who were negotiating stairs and getting in/out of the bed/chair were 3.12-fold and 2.97-fold, respectively, more likely to have a moderate/severe TBI than those who fell while walking. Falling backward and sideways was 4.07-fold and 2.30-fold, respectively, more likely to cause a moderate/severe TBI than falling forward. When patients with a mild-TBI were assigned to the control group, results were similar, with the exception that the effect of antiarrhythmic use became nonsignificant and subjects who took 2 or more medications were 3.07-fold more likely to have a moderate/severe TBI than those who took none.

CONCLUSION

Avoiding a head impact during a backward or sideways fall, reducing unnecessary use of polypharmacy and antiarrhythmics, and maintaining safety during stair negotiation and bed/chair transfer may protect an elderly person from a severe brain injury.

Visual Acuity, Visual Disabilities and Falling in the Elderly

Poor vision has been suggested as a risk factor for falling in the elderly. We analyzed the findings from a cohort of community-dwelling elderly (N = 875) to determine the relative risks for impaired visual acuity and various visual disabilities with falling, recurrent falling, and serious injurious falls. The prevalences of impaired visual acuity and four visual disabilities were low. None of the vision variables examined predicted time to first serious injurious fall after controlling for balance, cognition, age, and gender. However, bumping into objects predicted falling and recurrent falling. The lack of associations between visual disabilities and falling suggests that poor vision, as measured here, plays a limited role in predicting falling in relatively well community-dwelling elderly.

Rates and factors associated with falls in older European Americans, Afro-Caribbeans, African-Americans, and Hispanics

PURPOSE

To evaluate rates and factors associated with older adult falls in different ethnic groups.

PARTICIPANTS AND METHODS

Information on demographics, medical and falls history, and pain and physical activity levels was collected from 550 community-dwelling older adults (75±9 years old, 222 European Americans, 109 Afro-Caribbeans, 106 African-Americans, and 113 Hispanics).

RESULTS

Taking medications for anxiety (risk ratio [RR] =1.4, 95% confidence interval [CI] =1.1-2.0), having incontinence (RR =1.4, 95% CI =1.1-1.8, P=0.013), back pain (RR =1.4, 95% CI =1.0-1.8), feet swelling (RR =1.3, 95% CI =1.1-1.7), and age ≥75 years (RR =1.3, 95% CI =1.0-1.6) were associated with falls. The associations were stronger for Afro-Caribbeans, but they presented approximately 40% lower prevalence of falls than the other groups.

CONCLUSION

Taking anxiety medication, incontinence, back pain, feet swelling, and age ≥75 years were associated with falls, and Afro-Caribbeans presented lower prevalence of falls. These findings need to be taken into consideration in clinical interventions in aging.

Association between use of multiple psychoactive medicines and hospitalization for falls: retrospective analysis of a large healthcare claim database

Background

Little is known about the impact of taking multiple psychoactive medicines on the risk of hospitalization for falls.

Objective

To identify the association between multiple psychoactive medicine use and hospitalization for falls.

Methods

A retrospective cohort study was conducted between July 2011 and June 2012 in the Australian veteran population who had been dispensed at least one psychoactive medicine within the previous year. Psychoactive medicines with sedative properties included antipsychotics, anxiolytics, hypnotics, antidepressants, opioids, anti-epileptics, anti-Parkinson medicines and medicines for migraine. The associations between falls and the number of psychoactive medicines used or the number of doses were analysed in comparison with falls that occurred when no psychoactive medicine was used.

Results

The adjusted results showed a significantly increased risk of falls when patients were on one or more psychoactive medicines or were receiving 0.1–0.9 defined daily dose (DDD) or more per day. The incident rate ratios (IRRs) were 1.22 (95 % confidence interval [CI] 1.08–1.38) for those on one psychoactive medicine, 1.70 (95 % CI 1.45–1.99) for those on two, 1.96 (95 % CI 1.58–2.43) for those on three or four, and 3.15 (95 % CI 1.90–5.23) for those on five or more. A similar result was observed when the data were analysed by dose, with the highest risk being found for those taking three or more DDD per day (adjusted IRR 4.26, 95 % CI 2.75–6.58).

Conclusion

Increased numbers or increased doses of psychoactive medicines are associated with an increased risk of hospitalization for falls in older adults. Strategies to reduce the psychoactive medicine burden are likely to translate into significant health benefits.

Type, number or both? A population-based matched case-control study on the risk of fall injuries among older people and number of medications beyond fall-inducing drugs

Objectives

Drug use is a modifiable risk factor for fall-related injuries in older people. Whereas the injurious effect of polypharmacy is established, that of low numbers of medications has not been fully ascertained. Neither do we know whether it is the number per se or the type of medications that actually matters. We assessed this question for fall injuries leading to hospitalization.

Design

National register-based, population-based, matched case-control study.

Setting

Community dwellers aged 65+ years living in Sweden between March 2006 and December 2009.

Methods

Cases (n = 64,399) were identified in the national inpatient register and four controls per case were randomly matched by gender, date of birth and residential area. The association between number of prescribed medications, assessed through linkage with the Swedish prescribed drug register, and the risk of injurious falls was estimated with odds ratios with 95% confidence intervals using conditional logistic regression, adjusted for demographic and health status.

Results

The number of medications was associated with an increased risk of fall injury in a dose-response fashion, even after adjustment for marital status, comorbidity and number of fall-risk-inducing drugs (FRIDs). Using ten or more medications was associated with an almost two-fold higher risk (adjusted OR: 1.76, 95% CI: 1.66 to 1.88). When stratified by use (or not) of at least one FRID, the association weakened slightly among both non-users (adjusted OR: 1.50, 95% CI: 1.34 to 1.67) and users (adjusted OR: 1.67, 95% CI: 1.58 to 1.77).

Conclusion

In older people, not only large but also small numbers of medications may affect the risk for them to sustain injurious falls. Although the mechanisms lying behind this are complex, the finding challenges the prevention strategies targeting either specific types of medications (FRIDs) or high numbers of them.

Incidence and related clinical factors of falls among older Chinese veterans in military communities: a prospective study

[Purpose] The aim of this study was to determine fall incidence and explore clinical factors of falls among older Chinese veterans in military communities. [Subjects and Methods] We carried out a 12-month prospective study among 13 military communities in Beijing, China. Fall events were obtained by self-report to military community liaisons and monthly telephone interviews by researchers. [Results] Among the final sample of 447 older veterans, 86 fell once, 25 fell twice or more, and 152 falls occurred altogether. The incidence of falls and fallers were 342/1,000 person-years and 249/1,000 person-years. In Cox regression models, independent clinical factors associated with falls were visual acuity (RR=0.47), stroke (RR=2.43), lumbar diseases (RR=1.73), sedatives (RR=1.80), fall history in the past 6 months (RR=2.77), multiple chronic diseases (RR=1.53), multiple medications (RR=1.34), and five-repetition sit-to-stand test score (RR=1.41). Hearing acuity was close to being statistically significant. [Conclusion] The incidences of falls and fallers among older Chinese veterans were lower than those of Hong Kong and western countries. The clinical risk factors of falls were poor senses, stroke, lumbar diseases, taking sedatives, fall history in the past 6 months, having multiple chronic diseases, taking multiple medications, and poor physical function. The preventive strategies targeting the above risk factors are very significant for reducing falls.

Different risk-increasing drugs in recurrent versus single fallers: are recurrent fallers a distinct population?

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.

A multicenter, case-control study of the effects of antihypertensive therapy on orthostatic hypotension, postprandial hypotension, and falls in octo- and nonagenarians in residential care facilities

BACKGROUND

Orthostatic hypotension, postprandial hypotension, and falls are considered to be adverse drug reactions of antihypertensive therapy in older people with comorbidities. Concerns regarding these adverse events may limit the use of antihypertensive agents in this group of people.

OBJECTIVE

The aim of this study was to determine the relationship between antihypertensive therapy in octo- and nonagenarians and the risk for orthostatic hypotension, postprandial hypotension, and falls.

METHODS

This was a case-control study of octo- and nonagenarians living in residential care facilities who were receiving antihypertensive therapy and a control group who were not receiving antihypertensive therapy.

RESULTS

A total of 119 patients, 77 who were receiving regular antihypertensive therapy and 42 who were not taking any antihypertensive agents, were enrolled in the study. The prevalence of antihypertensive use, orthostatic hypotension, postprandial hypotension, and falls was high (65%, 29%, 57%, and 45%, respectively). There were no associations between antihypertensive therapy and orthostatic hypotension, postprandial hypotension, and falls. When individual classes of antihypertensive agents were examined, the only observed association was a negative association (ie, a protective effect) between potassium-sparing diuretics and falls (odds ratio, 0.2; 95% CI, 0.04-1.0).

CONCLUSION

Antihypertensive therapy was not associated with an increased risk for orthostatic hypotension, postprandial hypotension, or falls in this case-control study of octo- and nonagenarians living in residential care facilities.

Analytical review: focus on fall screening assessments

BACKGROUND

Falls and their associated injuries profoundly impact health outcomes, functional independence, and health care expenses, particularly for the ever-increasing elderly population. This systematic search and review assessed the current evidence for the role of fall screening assessments.

OBJECTIVE

To review the current evidence for fall risk screening assessments in community-dwelling (outpatient), inpatient medical and surgical wards, inpatient rehabilitation centers, and postrehabilitation outpatient settings.

DATA SOURCES

MEDLINE and Embase (January 1980 to December 2012).

STUDY SELECTION

Prospective validation studies of acute medical or surgical inpatients, acute rehabilitation inpatients, outpatients who completed acute inpatient rehabilitation, or community-dwelling elderly.

DATA EXTRACTION

Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristics with area under the curve.

RESULTS

We summarized key findings from 6 literature reviews. We then identified 31 articles: 12 studies in community setting, 13 in the acute medical inpatient or surgical inpatient setting, and 6 studies in the rehabilitation setting. Twenty-two studies not previously reviewed were included, and 9 studies previously reviewed were considered relevant and were included to allow comparison with data from the studies not previously reviewed.

CONCLUSION

We recommend consideration of 7 assessment tools to be used in conjunction with overall clinical evaluation to assess falls risk: the Timed Up and Go Test with a cutoff of >12.34 seconds and Functional Gait Assessment among community-dwelling elderly; St Thomas Risk Assessment Tool in medical inpatients <65 years old and surgical inpatients; Hendrich fall risk model II in medical inpatients; 10-Minute Walk Test in patients in poststroke rehabilitation; and Berg Balance Scale or the Step Test in patients in poststroke rehabilitation who had fallen during their inpatient stay.

Association between musculoskeletal pain and trips or falls in rural Japanese community-dwelling older adults: a cross-sectional study

AIM

The present study examined whether low back pain (LBP) and knee pain (KP) are associated with trips and falls in rural Japanese community-dwelling older adults.

METHODS

A population-based cross-sectional survey of community-dwelling older adults was carried out in Unnan City, Shimane Prefecture, in Japan. A total of 499 men and women aged 60 years and older living in the community were recruited from 2008 to 2010. The main outcome measures were self-rated recent trip frequency and self-reported experience of falls in the past year.

RESULTS

Trips and falls presented in 44.0% and 15.9% of participants, respectively. LBP was not associated with trips, but was significantly associated with falls: severe pain versus single fall (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.04-6.03); and severe pain versus multiple falls (OR 11.09, 95% CI 2.41-51.10). KP was significantly associated with trips: mild pain versus trips (OR 1.81, 95% CI 1.20-2.72); mild pain versus multiple falls (OR 4.47, 95% CI 1.21-16.50); severe pain versus trips (OR 3.83, 95% CI 1.82-8.04); and severe pain versus multiple falls (OR 7.26, 95% CI 1.51-34.86). Participants with both pain sites were associated with trips (OR 2.44, 95% CI 1.45-4.12) and multiple falls (OR 10.79, 95% CI 1.33-87.19).

CONCLUSIONS

Severe LBP was associated with single and multiple falls, whereas KP was associated with trips and multiple falls, irrespective of severity of pain. In addition, participants with both pain types were associated with trips and multiple falls.

Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative

Background

Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated.

Methods

This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (≥2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI.

Results

Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval [CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake.

Conclusion

These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use.

Managing falls in older patients with cognitive impairment

With an aging population, both dementia and fall-related injury pose an international health challenge. Individuals with dementia fall twice as often as cognitively intact people and are more likely to have injurious falls. Higher morbidity and rates of mortality and institutionalization after falls have also been reported in this group. There is limited but emerging literature that is attempting to define and explain why fall risk is increased in this population. This will allow for targeted fall prevention programs. Currently, there are no published randomized controlled trials that have prevented falls in community-dwelling cognitively impaired older people, and conflicting evidence is reported in hospital and residential care trials. Recent exercise interventions have demonstrated significant benefits, such as improved gait speed, strength and balance in people with cognitive impairment/dementia, providing encouraging evidence for further research and clinical interventions.

Depression as a predictor of falls amongst institutionalized elders

OBJECTIVE

In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents amongst institutionalized elderly people.

METHODS

A cross-sectional study was carried out to investigate the fall history of institutionalized elders involving 286 subjects. Experiences of falls over the previous year were recorded, with at least two falls during the prior one-year period, or one injurious fall defined as 'fallers'. The Geriatric Depression Scale-15 was used as a screening instrument for depression status.

RESULTS

Based on a multivariate logistic regression and stratification analysis, depression was found to have enhanced effects with various medical conditions on fall risk. As compared with the non-depressive reference group, a five-fold fall risk was discernible amongst depressed elders with multiple medications, whilst a six-fold risk was found amongst depressive elders using ancillary devices, along with a 11-fold amongst depressive elders with neural system diseases.

CONCLUSIONS

This study provides the evidence of enhancing effects between depression and medical conditions on the risk of falls amongst institutionalized elderly people. Thus, depressed elders with neural system diseases, using ancillary devices or multiple medications, should be specifically listed as very high risk of falling amongst institutionalized elderly, and strictly prevent them from falls. Screening and treatment of depression could also be a useful strategy in the prevention of falls amongst institutionalized elderly with poor medical condition.

In-Hospital Mortality and Unintentional Falls Among Older Adults in the United States

Purpose of the Study:

To estimate the odds of death associated with documented unintentional falls and acute care hospitalization among older adults in the United States.

Design and Method:

Data were abstracted from the 2005 Nationwide Inpatient Sample (NIS) and odds of death were modeled using logistic regression.

Results:

The age 65 and older fall rate per 1,000 discharges was 53.0 while the mortality rate for those who fell was 33.2. Older-old (odds ration [ OR] = 2.93; confidence interval [CI] = [2.50, 3.43]), men ( OR = 1.64, CI = [1.54, 1.75]), and non-White ( OR = 1.09; CI = [1.01, 1.19]) had higher odds of death compared to younger-old, women, and Whites. Additional comorbidity ( OR = 3.41, CI = [3.05, 3.82]), dehydration ( OR = 1.14; CI = [1.05, 1.25]) and intracranial fractures ( OR = 4.46; CI = [4.02, 4.95]) resulted in greater odds of death.

Implications:

Among older adults who experienced a fall and hospitalization, odds of mortality appear influenced by factors beyond injury severity related to falling. Additional research is necessary to delineate the mechanisms behind these phenomena to inform the public about falls-prevention programs.

Do behavioral disturbances predict falls among nursing home residents?

BACKGROUND AND AIMS

The purpose of our study was to examine whether severity of dementia, behavioral and psychological symptoms and depression can predict falls among nursing home residents, such as demographic variables, activities of daily living, and use of psychotropic drugs, when potential confounders are controlled for.

METHODS

1147 nursing home residents were examined in this one-year follow-up study. All residents were examined with the Physical Self-Maintenance scale (Activities of Daily Living - ADL), Clinical Dementia Rating Scale (CDR), Neuropsychiatric Inventory (NPI) and Cornell Scale for Depression in Dementia. Demographic data, gender, education, physical health and use of medication were collected from medical records.

RESULTS

40% of participants had at least one fall during the one-year follow-up period. Bivariate survival analysis revealed that low level of education, severe dementia, severe behavioral and psychological symptoms, severe depression, greater functional impairment, age, worsening in physical health, and use of sedatives, significantly predict one or more falls. Multivariate Cox regression analyses showed that age, higher scores on NPI and CDR, use of sedatives and dependency in ADL were all, independently of each other, predictors of an increased risk of falling.

CONCLUSIONS

Having a high NPI score was identified as a significant and independent predictor of falls. Since falling is a common event which causes considerable morbidity and mortality in older people, these findings are important for healthcare and for the individuals concerned. To prevent falling in nursing homes, special attention must be paid to residents with severe dementia, to behavioral symptoms and use of sedatives.

Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly

BACKGROUND

The use of benzodiazepines is associated with increased risk of fall-related injuries in the elderly. However, it is unclear if the risks vary across the products and how they depend on the pattern of use and dosage. Specifically, the possibility of cumulative effects of past benzodiazepine use has not been thoroughly investigated.

METHODS

We used the administrative database for a cohort of 23,765 new users of benzodiazepines, aged 65 years and older, in Quebec, Canada, between 1990 and 1994. The associations between the use of seven benzodiazepines and the risk of fall-related injuries were assessed using several statistical models, including a novel weighted cumulative exposure model. That model assigns to each dose taken in the past a weight that represents the importance of that dose in explaining the current risk of fall.

RESULTS

For flurazepam, the best-fitting model indicated a cumulative effect of doses taken in the last two weeks. Uninterrupted use of flurazepam in the past months was associated with a highly significant increase in the risk of fall-related injuries (HR = 2.83, 95% CI: 1.45-4.34). The cumulative effect of a 30-day exposure to alprazolam was 1.27 (1.13-1.42). For temazepam, the results suggested a potential withdrawal effect.

CONCLUSIONS

Mechanisms affecting the risk of falls differ across benzodiazepines, and may include cumulative effects of use in the previous few weeks. Thus, benzodiazepine-specific analyses that account for individual patterns of use should be preferred over simpler analyses that group different benzodiazepines together and limit exposure to current use or current dose.

Inferior field loss increases rate of falls in older adults with glaucoma

PURPOSE

To examine the visual predictors of falls and injurious falls among older adults with glaucoma.

METHODS

Prospective falls data were collected for 71 community-dwelling adults with primary open-angle glaucoma (mean age, 73.9 ± 5.7 years) for 1 year using monthly falls diaries. Baseline assessment of central visual function included high-contrast visual acuity and Pelli-Robson contrast sensitivity. Binocular integrated visual fields were derived from monocular Humphrey Field Analyzer plots. Rate ratios (RR) for falls and injurious falls with 95% confidence intervals (CIs) were based on negative binomial regression models.

RESULTS

During the 1-year follow-up, 31 (44%) participants experienced at least one fall and 22 (31%) experienced falls that resulted in an injury. Greater visual impairment was associated with increased falls rate, independent of age and gender. In a multivariate model, more extensive field loss in the inferior region was associated with higher rate of falls (RR, 1.57; 95% CI, 1.06 to 2.32) and falls with injury (RR, 1.80; 95% CI, 1.12 to 2.98), adjusted for all other vision measures and potential confounding factors. Visual acuity, contrast sensitivity, and superior field loss were not associated with the rate of falls; topical beta-blocker use was also not associated with increased falls risk.

CONCLUSIONS

Falls are common among older adults with glaucoma and occur more frequently in those with greater visual impairment, particularly in the inferior field region. This finding highlights the importance of the inferior visual field region in falls risk and assists in identifying older adults with glaucoma at risk of future falls, for whom potential interventions should be targeted.

Fatores associados a quedas em idosos residentes em um bairro de Fortaleza, Ceará

A queda é uma das consequências mais graves do envelhecimento, sendo reconhecida como importante problema de saúde pública. A pesquisa teve como objetivo investigar aspectos relacionados à ocorrência de quedas em idosos. Participaram do estudo 50 idosos, do bairro Cidade 2000, em Fortaleza-CE, sendo 64% do gênero feminino. Para a coleta de dados foi utilizado um questionário. Observou-se que 42% dos idosos apresentaram, no mínimo, um episódio de queda nos últimos dois anos, dos quais 19% se encontravam entre 60 e 69 anos, 24% entre 70 e 79 anos e 57% entre 80 e 89 anos. As causas foram principalmente relacionadas ao ambiente doméstico inadequado (57%). Dentre os fatores relacionados ao ambiente doméstico que favorecem as quedas, o mais citado foi a existência de superfícies escorregadias (33%). A maioria dos participantes (80%) fazia uso de algum tipo de medicação prescrita por médicos, sendo os anti-hipertensivos utilizados por 42% do grupo. A consequência mais comum das quedas foi a fratura, indicada por 43% dos idosos, tendo sido mais frequente a fratura de rádio (56%). Outras consequências citadas foram trauma craniano (19%), depressão (19%) e ansiedade (19%). Necessitaram de internação hospitalar 33% dos idosos vítimas de quedas. A pesquisa aponta que 60% do grupo praticam atividade física regular e, dentre os sedentários, encontravam-se 90% dos idosos que haviam sido acometidos por quedas. Conclui-se que as quedas podem ser entendidas como eventos que podem, em parte, ser evitados através da adoção de programas e medidas preventivas simples.

Thiazide diuretics and the risk of hip fracture

BACKGROUND

Thiazide diuretics are one of the most commonly prescribed antihypertensive agents worldwide. Thiazides reduce urinary calcium excretion. Chronic ingestion of thiazides is associated with higher bone mineral density. It has been suggested that thiazides may prevent hip fracture. However, there are concerns that diuretics, by increasing the risk of fall in elderly, could potentially negate its beneficial effects on hip fracture.

OBJECTIVES

To assess any association between the use of thiazide diuretics and the risk of hip fracture in adults.

SEARCH STRATEGY

We searched eligible studies up to December 2008 in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Pharmaceutical Abstracts, the Database of Abstracts of Review of Effects (DARE) and reference lists of previous reviews and included studies.

SELECTION CRITERIA

All randomized controlled trials and observational studies, which assessed the association between thiazide diuretic use and hip fracture.

DATA COLLECTION AND ANALYSIS

Two review authors independently applied the selection criteria, extracted data and assessed risk of bias of each study selected.  The results were summarized descriptively and quantitatively. Cohort studies and case control studies were analysed separately.

MAIN RESULTS

No randomized control trials were found. Twenty-one observational studies with nearly four hundred thousand participants were included. Six of them were cohort studies and 15 were case-control studies. Two cohort studies appear to involve the same cohort so there were only 5 unique ones. The risk of bias was assessed with the Newcastle-Ottawa Scale (NOS). Five cohort studies had low risk of bias and one had moderate risk of bias. Seven case control studies had low risk of bias and 8 had moderate risk of bias. Meta-analysis of cohort studies showed that thiazide use was associated with a reduction in risk of hip fracture by 24%, pooled RR 0.76 (95% CI 0.64-0.89; p = 0.0009). We chose not to provide a pooled summary statistics for case-control studies because of high heterogeneity (Tau(2) = 0.03, I(2) = 62%, p = 0.0008).

AUTHORS' CONCLUSIONS

Thiazides appear to reduce the risk of hip fracture based on observational studies. Randomized controlled trials are needed to confirm these findings.  

Laxatives as a risk factor for iatrogenic falls in elderly subjects: myth or reality?

BACKGROUND

The multifactorial nature of falls is well known, and several studies on falls in the elderly have reported that laxatives can be a risk factor, but without attempting to discuss possible mechanisms to explain this role.

OBJECTIVE

We aimed to isolate studies in which the risk factors for falls in the elderly related to laxatives have been evaluated and to carry out a meta-analysis combining the results of all identified good-quality studies.

METHODS

Systematic literature review using the keywords 'accidental fall/numerical data' and 'risk factors'. This was followed by a manual search for articles cited in the previously identified publications. Articles were analysed if they had study populations aged ≥60 years, reported on falls occurring in everyday life, were observational or interventional studies that identified laxatives as a risk factor for falls, and were written in French or English. Articles of this type that were considered to be of good quality were included in the meta-analysis.

RESULTS

3747 indexed articles published between 1981 and 2007 were identified. Of these, seven articles met all inclusion criteria and were analysed. The odds ratio (95% CI) for the association between use of laxatives and fall occurrence in subjects participating in the good-quality trials (n = 4) included in the meta-analysis was 2.03 (1.52, 2.72). This result was statistically homogeneous (percentage of the total variation across studies due to heterogeneity [I2] = 0).

CONCLUSIONS

Elderly subjects treated with laxatives were twice as likely to fall compared with non-laxative users. The causal relationship was probably not directly attached to a side effect of the substance used, but rather a reflection of other pathologies (e.g. older age, confinement to bed, concomitant Parkinson's disease) that may themselves cause falls.

Medication use as a risk factor for inpatient falls in an acute care hospital: a case-crossover study

AIMS

The present study aimed to evaluate the associations between medication use and falls and to identify high risk medications that acted as a trigger for the onset of falls in an acute care hospital setting.

METHODS

We applied a case-crossover design wherein cases served as their own controls and comparisons were made within each participant. The 3-day period (days 0 to -2) and the 3-day periods (days -6 to -8, days -9 to -11 and days -12 to -14) before the fall event were defined as the case period and the control periods, respectively. Exposures to medications were compared between the case and control periods. Odds ratios (OR) and 95% confidence intervals (CI) for the onset of falls with respect to medication use were computed using conditional logistic regression analyses.

RESULTS

A total of 349 inpatients who fell during their hospitalization were recorded on incident report forms between March 2003 and August 2005. The initial use of antihypertensive, antiparkinsonian, anti-anxiety and hypnotic agents as medication classes was significantly associated with an increased risk of falls, and these ORs (95% CI) were 8.42 (3.12, 22.72), 4.18 (1.75, 10.02), 3.25 (1.62, 6.50) and 2.44 (1.32, 4.51), respectively. The initial use of candesartan, etizolam, biperiden and zopiclone was also identified as a potential risk factor for falls.

CONCLUSIONS

Medical professionals should be aware of the possibility that starting a new medication such as an antihypertensive agent, including candesartan, and antiparkinsonian, anti-anxiety and hypnotic agents, may act as a trigger for the onset of a fall.

Beers-Fick criteria and drugs available through the Farmácia Dose Certa program

CONTEXT AND OBJECTIVE

Farmácia Dose Certa is a program available in the State of São Paulo that is a national reference for providing drugs free of charge to the population. Elderly people receiving care deserve special attention regarding drugs that are appropriate for their age group. The objective was to assess the drugs in the program considered to be inappropriate for the elderly.

DESIGN AND SETTING

Descriptive study evaluating free drug distribution in the State of São Paulo, Brazil.

METHODS

Following the criteria proposed by Beers and Fick (drugs or drug classes that should be avoided among elderly people, independent of the diagnosis or clinical condition, because of the high risk of side effects and because other, safer drugs are available), the drugs in the Farmácia Dose Certa program that might be inappropriate for elderly people and the levels of evidence for each drug included were assessed.

RESULTS

Among the available drugs, 10 (25.6%) were included within the Beers-Fick criteria. The drugs selected were: amitriptyline, cimetidine, diazepam, digoxin, fluoxetine, methyldopa, nifedipine, promethazine, thioridazine and ferrous sulfate.

CONCLUSION

The list of drugs available within the Farmácia Dose Certa program may be considered appropriate for the general population, but not completely for the elderly population. Adjusting this list to the pharmacological aspects of aging will reduce the risks of drug interactions, falls, mental confusion and excessive sedation that result from drugs that are considered inappropriate for consumption by elderly people.

Psychotropic Drugs and Falls in the Elderly People: Updated Literature Review and Meta-Analysis

Objective: To carry out meta-analyses on psychotropic drugs and to provide an update of the risk of falling in the elderly people related to psychotropic drugs. Design: Meta-analyses of studies on psychotropic drugs. Results: 177 studies are included, of which 71 have data on risk factors associated with psychotropic drugs. The odds ratio and 95% Cl for associations between use of psychotropic drugs and fall are 1.78 and 1.57-2.01, respectively. This result is statistically heterogeneous. This heterogeneity disappears in the group of very old participants for each class. Conclusion: Our study confirms the association between falls in the elderly people and psychotropic drugs. These results are similar to those of former meta-analyses but with different methods. It shows that these meta-analyses on psychotropic drugs have a small impact on prescribing habits. They only give evidence to support the association between psychotropic drugs and falls even if there is no proven link.

Farm work exposure of older male farmers in Saskatchewan

BACKGROUND

The average age of farmers in North America is increasing each year. Research has determined that age and health status are both related to increased risk of injury. The purpose of this research was to determine the association of health and medication factors with exposure to farm work in older male farmers.

METHODS

As part of a cohort study to study determinants of injury on Saskatchewan farms, 5,502 farm people associated with 2,386 Saskatchewan farms were surveyed by mail questionnaire during the winter of 2007. The primary dependent variable was average hours per week of farm work. Independent variables included illnesses, age, and medication use.

RESULTS

The mean number of hours worked per week by farmers aged 55 years and older was 48. There was a significant relationship between age and hours worked with each year of age accounting for about 0.85 hr less work per week. Medication use was related to a reduction in weekly work hours during the busy fall season but was not related to work exposure averaged over the whole year. In multivariable linear regression analysis, the main contributing variables to farm work exposure were: retired status (-), working off farm (-), and age (-).

CONCLUSION

The amount of hours older farmers work on the farm is considerable compared to any other occupational category. While there is a declining trend in the amount of work, a 75-year-old farmer still works, on average, about 34 hr per week. Some farmers do appear to self-limit during busy times of the year if they are taking medication.

Risk Factors for Serious Falls Among Community-Based Seniors: Results from the National Population Health Survey

This paper examines factors associated with falling among approximately 3,100 individuals aged 65 and older who were participants in the 1994 National Population Health Survey (NPHS). The intent of the NPHS is to monitor the health of Canadians and risk factors that affect their health. Several factors were identified as increasing the risk of falling, such as advanced age, being female, certain medical conditions, medication use and impaired mobility. The results from this survey, conducted on a national level, confirm the findings of many studies utilizing smaller samples within individual communities. Continuation of the NPHS will aid in offering longitudinal data with respect to falls, and allow for establishing a temporal order prior to the fall event, in order to provide more definitive evidence with respect to risk factors for falls.

A Cross-Sectional Study of the Prevalence, Correlates, and Costs of Falls in Older Home Care Clients ‘At Risk’ for Falling

Cette étude a examiné la prévalence pendant 6 mois, à l’aide des services de soutien à domicile, des facteurs de risque et des coûts de chutes de personnes âgées qui sont à risque de chute. Des 109 participants, 70,6 pour cent ont indiqué une chute dans les six mois précédents et 27,5 pour cent ont éprouvé plusieurs chutes. Bien qu’il n’y avait aucune différence statistiquement significative dans n’importe quel facteur de risque lié à la chute parmi ceux qui sont tombés (1+ chutes) et ceux qui ne sont pas tombés (0 chutes), ceux qui sont tombés ont montrés des tendances de plus en plus évidentes de fonctionnement réduit sur le plan physique, social et psychologique. Dans le coût total par personne d’utilisation des services de santé au cours des 6 derniers mois, il n’y avait aucune différence statistiquement significative entre ceux qui sont tombés et ceux qui ne sont pas tombés; toutefois, il y avait des différences significatives entre les groupes dans certains types de services de santé. L’analyse multivariable a révélé la présence de cinq facteurs de risques de chutes: troubles neurologiques (p. ex., diminution cognitive, maladie de Parkinson), l’âge ≥85 ans, risques environnementaux, glissade ou trébuchant précédente et déficience visuelle.

Risk factors for falling among community-based seniors

BACKGROUND

Falling constitutes a significant risk to the health and well-being of seniors. Although a number of risk factors have been established within the literature for falling, limited work has differentiated risk factors for 1-time versus recurrent or multiple fallers.

METHODS

The purpose of this research was to examine 2 relationships: (1) the risk factors for nonfallers versus fallers (1+ falls); and (2) the risk factors for nonfallers/1-time fallers versus multiple fallers (2+ falls). All participants (n = 453) were subjects within 5 different fall intervention programs funded through the Falls Prevention Initiative sponsored by Health Canada and Veterans Affairs Canada. In total, 5 project sites funded in Ontario conducted independent fall intervention programs. At the onset of their programs and at the completion of their programs, each project site assessed all of their subjects or a predetermined number of seniors (if the subject pool was extensive) using 2 instruments, namely the interRAI Community Health Assessment and the Berg Balance Scale, so that comparisons could be made between sites.

RESULTS

Of the 453 individuals, 67% of the sample was classified as nonfallers, with 33% classified as experiencing 1 or more falls. Risk factors significant within the model examining nonfallers versus 1+ fallers included increased medication use and a previous history of falling. For the second analyses, examining 0 falls/1 fall versus recurrent fallers, the following factors were associated with increased risk: medication use, previous history of falling, and compromised activities of daily living (ADL). Fourteen percent of the sample experienced 2+ falls.

CONCLUSIONS

It is important to distinguish fallers based on fall status because recurrent or multiple fallers are more likely to benefit from fall prevention efforts. Using a standardized and comprehensive tool such as the interRAI-CHA would assist researchers in making comparisons between different research groups.

Medication use and increased risk of falls in hospitalized elderly patients: a retrospective, case-control study

BACKGROUND

Falls in the elderly are common and often serious. Several drugs have been associated with increased fall risk. Older adults often take numerous medications for multiple chronic conditions, so are at increased risk for drugs that potentially cause falls.

OBJECTIVE

We studied the association between drug use and falls in recently hospitalized older people in order to identify medications that may increase the risk of falls in this population.

METHODS

A retrospective case control study was performed in the geriatric department of Bertinot Juel Hospital, Chaumont en Vexin, Picardy, France. We assessed the incidence of patient falls during hospitalization in 2004 and 2005 in an acute geriatric ward. We compared medications taken by all patients who fell (134 cases) with those taken by patients who did not fall (126 controls). The 260 participants were all aged >or=65 years.

RESULTS

50% of falls occurred in the first week after admission. In 16% of cases, falls were classified as severe. The characteristics of the two groups (patients who fell and those who did not) were similar: no significant differences were observed in terms of age, sex, number of medicines or prevalence of hypertension or Parkinson's disease. The probability of falls increased when the patients used zolpidem (adjusted odds ratio [AOR] 2.59; 95% CI 1.16, 5.81; p = 0.02), meprobamate (AOR 3.01; 95% CI 1.36, 6.64; p = 0.01) or calcium channel antagonists (AOR 2.45; 95% CI 1.16, 4.74; p = 0.02).

CONCLUSIONS

Some drugs are associated with an increased risk of falls in the elderly and, when alternatives exist, should be avoided until cohort studies are conducted to confirm or refute these possible increased risks.

Health, medication use, and agricultural injury: A review

BACKGROUND

Agricultural work in the United States and Canada continues to be one of the most dangerous vocations. Surveillance evidence suggests that older farmers (>60 years of age) are at greater risk of serious injury than their younger counterparts. The purpose of this article was to outline illnesses and medications that may contribute to older farmers' increased risk of agricultural injury and to determine a minimum set of health-related covariates that could be used in farm injury studies.

METHODS

A review of English language literature in Medline, CINAHL, and NIOSH databases was conducted examining disease and medication factors related to farm injury.

RESULTS

Health- and disease-related factors most commonly reported as significantly contributing to agricultural injury included previous injury, hearing problems, depression, arthritis, and sleep deprivation. The use of "any medication" was identified as a significant risk factor for injury in a number of studies. The use of sleep medication was significantly related to injury in two studies.

CONCLUSIONS

Based on the findings, it is recommended that at a minimum, researchers collect information on the prevalence of previous injury, hearing problems, depression, arthritis/muscular-skeletal problems and sleep disturbance as these have been identified as significant risk factors in a number of studies. In addition, where subjects that identify any of these afflictions, further information should be sought on any medications used in their treatment which can add data on disease severity. More research and surveillance activities need to be focused on the older farm worker. This population is critical to the maintenance of the agricultural base in North America and health and safety research initiatives need to address this. By integrating research from the fields of gerontology, occupational health and safety, and injury prevention, innovative interventions could be constructed to assist the aging farmer in the continuation of safe farming.

DHS e OPS: estudo comparativo da falência de osteossíntese

OBJETIVO: O presente estudo visa analisar prospectivamente dois tipos de osteossíntese (Dynamic Hip Screw (DHS), Orlando Pinto Souza (OPS)), utilizados para o tratamento de fraturas do fêmur proximal, quanto à ocorrência de "cut out". MATERIAIS E MÉTODOS: Foram realizadas no período de julho a dezembro de 2003, 52 cirurgias para tratamento de fraturas transtrocanterianas, 38 destas foram alvo do presente estudo. A técnica a ser utilizada foi escolhida por sorteio no ato operatório. RESULTADOS: No grupo onde fora implantado OPS não observamos a presença de "cut out" e no grupo do DHS obtivemos duas falências da síntese, uma em um paciente de sexo feminino portadora de fratura tipo Tronzo IV e outra em paciente do sexo masculino, portador de fratura Tronzo III, ambas classificadas como instáveis após a redução em mesa ortopédica. A média do TAD obtida foi de 31 mm para o grupo do DHS e de 56,63 mm para o OPS. CONCLUSÃO: Concluímos que quando Comparamos ambas as osteossínteses quanto à incidência de "cut out" e sua relação com o índice TAD preconizado por Baumgartner, no OPS o "cut out" não esteve dependente desta medida e que outros fatores como valgização e redução foram prioritários enquanto no DHS o índice TAD deve ser buscado.