Drug burden and falls risk

elderly couple silhouette made from pills

Older people taking multiple high-risk medications for sleeping, pain or incontinence are twice as likely to fall and break bones, new research has shown

And many die within a year of such an injury, the research, from the University of Otago, Christchurch and published in the Journals of Gerontology, has found.

The study is the first in the world to measure the impact taking multiple such medications can have on elderly people.

The researchers plan to use the data in a nationwide study of pharmacy databases to determine whether prescriptions of certain high-risk drugs can be reduced among the elderly.

The research, Drug Burden Index and Its Association With Hip Fracture Among Older Adults: A National Population-Based Study, was led by geriatrician and University of Otago, Christchurch researcher Dr Hamish Jamieson, with Professor Phil Schluter from the University of Canterbury the lead biostatistician. The study also involved scientists from six other Universities, including Harvard and John Hopkins Universities and the Universities of Sydney and Canterbury.

The research found that people taking more than three Drug Burden Index medications, which sedate or affect cognition, are twice as likely to break their hip than those taking no medications.

Between 20% and 30% elderly who broke their hip died within a year, and in the elderly, 90% of all broken bones are the result of falls.

The study was a competing-risks regression analysis conducted on older people living in New Zealand communities who had a standardised (International Resident Assessment Instrument) assessment between September 1, 2012, and October 31, 2015, the study’s end date

Among 70,553 adults assessed, 2,249 (3.2%) experienced at least one hip fracture, 20,194 (28.6%) died without experiencing a fracture, and 48,110 (68.2%) survived without a fracture. DBI was significantly related to fracture incidence in unadjusted and adjusted analyses.

Dr Jamieson says understanding how taking multiple medications impacts on falls and broken bones is a significant piece of information for patients, their GPs and pharmacists.

“Reducing polypharmacy and identifying at-risk medications is generally important,” the study says. “Up to 50% of older people have exposure to medications with anticholinergic properties.

“These data indicate that the total anticholinergic and sedative load should be considered particularly in the context of reducing fractures rates in the frail older population.”

Dr Jamieson says that “All medications have beneficial impacts”.  

“However, increasingly we are studying the long term side effects of medications in the elderly.  

“The impacts can be subtle but this can cause a major impact in the frail elderly and can cause falls, loss of independence and even premature death.”

Dr Jamieson says a number of factors predispose the elderly to medication side effects. This includes not being able to metabolise medications as well as young people, being on multiple medications, and frail and more susceptible to side effects.

Rather than stopping medications themselves, elderly patients should regularly get their GP to review their medication.

The authors write that one of the study’s strengths was that adjusting for a suite of potential confounders (including baseline function and medical comorbidities), the dose response relationship between DBI scores and fractures increased.

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