3
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Fall Risk-Increasing Drugs, Polypharmacy, and Falls Among Low-Income Community-Dwelling Older Adults

      research-article
      , MD, PhD, MPH 1 , 2 , , BSc 3 , , PhD 3 , , PhD 4
      , PhD, FGSA
      Innovation in Aging
      Oxford University Press
      Falls risk, Medication exposure, Pharmacoepidemiology, Prescription guidance

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background and Objectives

          Medication exposure is a potential risk factor for falls and subsequent death and functional decline among older adults. However, controversy remains on the best way to assess medication exposure and which approach best predicts falls. The objective of the current study was to examine the association between different measures of medication exposure and falls risk among community-dwelling older adults.

          Research Design and Methods

          This retrospective cohort study was conducted using Falls Free PA program data and a linked prescription claims data from Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly program. Participants were community-dwelling older adults living in Pennsylvania, United States. Three measures of medication exposure were assessed: (a) total number of regular medications (polypharmacy); (b) counts of potentially inappropriate medications derived from current prescription guidance tools (Fall Risk-Increasing Drugs [FRIDs], Beers Criteria); and (c) medication burden indices based on pharmacologic mechanisms (Anticholinergic Cognitive Burden, Drug Burden Index) all derived from claims data. The associations between the different medication risk measures and self-reported falls incidence were examined with univariate and multivariable negative binomial regression models to estimate incidence rate ratios (IRRs).

          Results

          Overall 343 older adults were included and there were 236 months with falls during 2,316 activity-adjusted person-months (10.2 falls per 100 activity-adjusted person-months). Of the 6 measures of medication risk assessed in multivariate models, only the use of 2 or more FRIDs (adjusted IRR 1.67 [95% CI: 1.04–2.68]) independently predicted falls risk. Among the 13 FRID drug classes, the only FRID class associated with an increased fall risk was antidepressants.

          Discussion and Implications

          The presence of multiple FRIDs in a prescription is an independent risk factor for falls, even in older adults with few medications. Further investigation is required to examine whether deprescribing focused on FRIDs effectively prevents falls among this population.

          Related collections

          Most cited references37

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

          Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

            (2019)
            The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674-694, 2019.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

              (2015)
              The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.
                Bookmark

                Author and article information

                Contributors
                Role: Decision Editor
                Journal
                Innov Aging
                Innov Aging
                innovateage
                Innovation in Aging
                Oxford University Press (US )
                2399-5300
                2021
                08 January 2021
                08 January 2021
                : 5
                : 1
                : igab001
                Affiliations
                [1 ] Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine , Kanagawa, Japan
                [2 ] Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital , Kanagawa, Japan
                [3 ] Department of Biomedical Informatics, University of Pittsburgh , Pennsylvania, USA
                [4 ] Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health , Pennsylvania, USA
                Author notes
                Address correspondence to: Kenya Ie, MD, PhD, MPH, Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 1-30-37 Shukugawara, Kawasaki, Kanagawa 214-8525, Japan. E-mail: kenya.ie@ 123456marianna-u.ac.jp
                Author information
                http://orcid.org/0000-0002-1387-0588
                http://orcid.org/0000-0001-6786-9956
                Article
                igab001
                10.1093/geroni/igab001
                7899132
                33644415
                58945625-9c83-44ad-a9a8-b34fba8cba14
                © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 June 2020
                : 24 December 2020
                : 22 February 2021
                Page count
                Pages: 9
                Funding
                Funded by: Centers for Disease Control and Prevention, DOI 10.13039/100000030;
                Award ID: DP002657
                Funded by: Prevention Research Centers program;
                Funded by: National Institute on Aging, DOI 10.13039/100000049;
                Award ID: K01 AG044433
                Funded by: U.S. National Library of Medicine, DOI 10.13039/100000092;
                Award ID: R01 LM011838
                Funded by: National Institutes of Health, DOI 10.13039/100000002;
                Award ID: AG024827
                Funded by: Pittsburgh Older Americans Independence Center;
                Categories
                Original Reports
                AcademicSubjects/SOC02600

                falls risk,medication exposure,pharmacoepidemiology,prescription guidance

                Comments

                Comment on this article