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Liu E, Nahid M, Musse M, Chen L, Hilmer SN, Zullo A, Kwak MJ, Lachs M, Levitan EB, Safford MM, Goyal P. Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure. BMC Cardiovasc Disord 2023; 23:372. [PMID: 37495948 PMCID: PMC10373421 DOI: 10.1186/s12872-023-03401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden. METHODS We used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003-2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003-2017. We determined FRIDs -cardiovascular (CV) and non-cardiovascular (non-CV) medications - at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors. RESULTS Among 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14). CONCLUSIONS FRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.
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Affiliation(s)
- Esther Liu
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Mahad Musse
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Ligong Chen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah N Hilmer
- The University of Sydney and Royal North Shore Hospital, Sydney, NSW, Australia
| | - Andrew Zullo
- Brown University School of Public Health, Providence, USA
| | | | - Mark Lachs
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | | | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, Weill Medical College of Cornell University, 525 East 68Th Street, New York, NY, 10021, USA.
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Jung YS, Suh D, Kim E, Park HD, Suh DC, Jung SY. Medications influencing the risk of fall-related injuries in older adults: case-control and case-crossover design studies. BMC Geriatr 2023; 23:452. [PMID: 37481554 PMCID: PMC10363319 DOI: 10.1186/s12877-023-04138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/27/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Medications influencing the risk of fall-related injuries (FRIs) in older adults have been inconsistent in previous guidelines. This study employed case-control design to assess the association between FRIs and medications, and an additional case-crossover design was conducted to examine the consistency of the associations and the transient effects of the medications on FRIs. METHODS This study was conducted using a national claims database (2002-2015) in Korea. Older adults (≥ 65 years) who had their first FRI between 2007 and 2015 were matched with non-cases in 1:2 ratio. Drug exposure was examined for 60 days prior to the date of the first FRI (index date) in the case-control design. The hazard period (1-60 days) and two control periods (121-180 and 181-240 days prior to the index date) were investigated in the case-crossover design. The risk of FRIs with 32 medications was examined using conditional logistic regression after adjusting for other medications that were significant in the univariate analysis. In the case-crossover study, the same conditional model was applied. RESULTS In the case-control design, the five medications associated with the highest risk of FRIs were muscle relaxants (adjusted odd ratio(AOR) = 1.35, 95% confidence interval (CI) = 1.31-1.39), anti-Parkinson agents (AOR = 1.30, 95%CI = 1.19-1.40), opioids (AOR = 1.23, 95%CI = 1.19-1.27), antiepileptics (AOR = 1.19, 95%CI = 1.12-1.26), and antipsychotics (AOR = 1.16, 95%CI = 1.06-1.27). In the case-crossover design, the five medications associated with the highest risk of FRIs were angiotensin II antagonists (AOR = 1.87, 95%CI = 1.77-1.97), antipsychotics (AOR = 1.63, 95%CI = 1.42-1.83), anti-Parkinson agents (AOR = 1.58, 95%CI = 1.32-1.85), muscle relaxants (AOR = 1.42, 95%CI = 1.35-1.48), and opioids (AOR = 1.35, 95%CI = 1.30-1.39). CONCLUSIONS Anti-Parkinson agents, opioids, antiepileptics, antipsychotics, antidepressants, hypnotics and sedatives, anxiolytics, muscle relaxants, and NSAIDs/antirheumatic agents increased the risk of FRIs in both designs among older adults. Medications with a significant risk only in the case-crossover analysis, such as antithrombotic agents, calcium channel blockers, angiotensin II antagonists, lipid modifying agents, and benign prostatic hypertrophy agents, may have transient effects on FRIs at the time of initiation. Corticosteroids, which were only associated with risk of FRIs in the case-control analysis, had more of cumulative than transient effects on FRIs.
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Affiliation(s)
- Yu-Seon Jung
- Chung-Ang University College of Pharmacy, 84 Heukseok-Ro, Dongjak-Gu, Seoul, South Korea
| | - David Suh
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eunyoung Kim
- Chung-Ang University College of Pharmacy, 84 Heukseok-Ro, Dongjak-Gu, Seoul, South Korea
| | - Hee-Deok Park
- Chung-Ang University College of Pharmacy, 84 Heukseok-Ro, Dongjak-Gu, Seoul, South Korea
| | - Dong-Churl Suh
- Rutgers, The State University of New Jersey School of Pharmacy, 160 Frelinghuysen Rd, Piscataway, NJ, USA.
| | - Sun-Young Jung
- Chung-Ang University College of Pharmacy, 84 Heukseok-Ro, Dongjak-Gu, Seoul, South Korea.
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Gemmeke M, Koster ES, van der Velde N, Taxis K, Bouvy ML. Establishing a community pharmacy-based fall prevention service - An implementation study. Res Social Adm Pharm 2022; 19:155-166. [PMID: 35995694 DOI: 10.1016/j.sapharm.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Community pharmacists are in the position to contribute to fall prevention, but this is not yet common practice. OBJECTIVE The aim of this study was to evaluate the implementation of a community pharmacy-based fall prevention service. METHODS A fall prevention service, consisting of a fall risk screening and assessment including a medication review, was implemented in pharmacies during three months. A preparative online training was provided to the pharmacy team to enhance adoption of the service. Included patients were aged ≥70 years, using ≥5 drugs of which ≥1 fall risk-increasing drug. The implementation process was quantitively assessed by registering medication adaptations, recommendations, and referrals. Changes in patient scores on the Short Fall Efficacy Scale-International (FES-I) and a fall prevention knowledge test were documented at one month follow-up. Implementation was qualitatively evaluated by conducting semi-structured interviews with pharmacists before and after the project, based on the consolidated framework of implementation research. RESULTS The service was implemented in nine pharmacies and 91 consultations were performed. Medication was adapted of 32 patients. Patients' short FES-I scores were significantly higher at follow-up (p = 0.047) and patients' knowledge test scores did not differ (p = 0.86). Pharmacists experienced the following barriers: lack of time, absence of staff, and limited multidisciplinary collaboration. Facilitators were training, motivated staff, patient engagement, and project scheduling. CONCLUSION The service resulted in a substantial number of medication adaptations and lifestyle recommendations, but many barriers were identified that hamper the sustained implementation of the service.
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Affiliation(s)
- Marle Gemmeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Katja Taxis
- Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
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Maly J, Dosedel M, Vosatka J, Mala-Ladova K, Kubena AA, Brabcova I, Hajduchova H, Bartlova S, Tothova V, Vlcek J. Pharmacotherapy as major risk factor of falls - analysis of 12 months experience in hospitals in South Bohemia. J Appl Biomed 2019; 17:60. [PMID: 34907747 DOI: 10.32725/jab.2019.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/09/2019] [Indexed: 11/05/2022] Open
Abstract
This study aimed to analyze the effect of fall risk-increasing drugs (FRIDs) and drug-related factors relative to falls through clinical pharmacy service in hospitalized patients, focusing on the relevance of clinical pharmacist evaluation in the context of physician assessment. A prospective study of inpatient falls was conducted in 2017 retrieving data from 4 hospitals in South Bohemia, Czech Republic. An online database was developed to collect patient and fall-related data, and fall evaluation records. Healthcare professionals classified the overall effect of drugs on falls using Likert scale. Univariate and multivariate correlations were performed with a significance level of p < 0.05. Out of the total 280 falls (mean age of patients 77.0 years), a mean of 2.8 diagnoses with fall-related risk, 8.8 drugs, and 4.1 FRIDs per fall were identified. Incidence of falls decreased quarterly (p < 0.001). Use of FRIDs were positively associated with increasing age (p = 0.007). Clinical pharmacists were more likely to identify pharmacotherapy as the relevant fall-related risk, compared to physicians evaluation (p < 0.001). An increasing total number of prescribed drugs as well as higher number of FRIDs increased the suspicion in both professionals in the context of drug-related causes of falls.
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Affiliation(s)
- Josef Maly
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Martin Dosedel
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Jan Vosatka
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Ales Antonin Kubena
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
| | - Iva Brabcova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Hana Hajduchova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Sylva Bartlova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Valerie Tothova
- University of South Bohemia in Ceske Budejovice, Faculty of Health and Social Sciences, Institute of Nursing, Midwifery and Emergency Care, Ceske Budejovice, Czech Republic
| | - Jiri Vlcek
- Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy, Hradec Kralove, Czech Republic
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