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Medication and medical diagnosis as risk factors for falls in older hospitalized patients.
- Source :
-
European Journal of Clinical Pharmacology . Aug2019, Vol. 75 Issue 8, p1117-1124. 8p. 2 Charts. - Publication Year :
- 2019
-
Abstract
- Objective: To examine the impact of medication and medical conditions on the fall risk in older hospitalized patients. Design: Matched case-control study. Setting: Large regional hospital in a mid-sized German city. Subjects: Four hundred eighty-one inpatients aged ≥ 65 years who fell during hospitalization ("cases") and a control group of 481 controls, matched for age, gender, and hospital department. Methods: Diagnosis, medication, vital parameters, and injuries were compared between cases and controls. Univariate and multivariable odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. Main results: Several drugs were significantly associated with falls in multivariate analyses: long-acting benzodiazepines (adjusted OR = 3.49; 95%-CI = 1.16–10.52), serotonin-noradrenalin reuptake inhibitors (SNRI) (2.57; 1.23–5.12), Z-drugs (2.29; 1.38–3.59), low-potency neuroleptics (1.87; 1.08–3.23), ACE inhibitors/sartans (1.42; 1.07–1.89). Digoxin (0.32; 0.11–0.99) and aldosterone receptor antagonists (0.54; 0.33–0.88) were negatively associated with falls. No significant association in multivariate analyses was found for short- and intermediate-acting benzodiazepines, mirtazapine, and opioids. Hyponatremia (1.52; 1.15–2.03) and leukocytosis (1.39; 1.05–1.87) in blood examination on admission showed significant association with falls. As secondary diagnoses, Parkinson syndrome (2.38; 1.27–4.46) and delirium (3.74; 2.26–6.21) were strongly associated with falls. The use of more than one psychoactive drug was a separate risk factor for falls (p < 0.0001). Conclusion: Several drugs including SNRI, neuroleptics, and Z-drugs showed a significant association with inpatient falls. The frequently prescribed tetracyclic antidepressant mirtazapine did not appear to increase the risk of falls. Psychoactive polypharmacy should be avoided. [ABSTRACT FROM AUTHOR]
- Subjects :
- *DIAGNOSIS of delirium
*PARKINSON'S disease diagnosis
*AGE distribution
*ELDER care
*HOSPITAL care of older people
*ALDOSTERONE antagonists
*ACE inhibitors
*ANTIPSYCHOTIC agents
*BENZODIAZEPINES
*BLOOD testing
*CONFIDENCE intervals
*DELIRIUM
*DIGOXIN
*ACCIDENTAL falls
*HYPONATREMIA
*LEUCOCYTE disorders
*MULTIVARIATE analysis
*NORADRENALINE
*PARKINSON'S disease
*PSYCHIATRIC drugs
*RISK assessment
*SEROTONIN uptake inhibitors
*SEX distribution
*STATISTICS
*TRANQUILIZING drugs
*CASE-control method
*ANGIOTENSIN receptors
*ODDS ratio
*DISEASE complications
*OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 00316970
- Volume :
- 75
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- European Journal of Clinical Pharmacology
- Publication Type :
- Academic Journal
- Accession number :
- 137507143
- Full Text :
- https://doi.org/10.1007/s00228-019-02668-3