Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Geriatr Gerontol Int. 2012 Jul;12(3):425-30. doi: 10.1111/j.1447-0594.2011.00783.x. Epub 2011 Dec 23.
To investigate the predictors of falls, such as comorbidity and medication, in geriatric outpatients in a longitudinal observational study.
A total of 172 outpatients (45 men and 126 women, mean age 76.9 ± 7.0 years) were evaluated. Physical examination, clinical history and medication profile were obtained from each patient at baseline. These patients were followed for up to 2 years and falls were self-reported to their physicians. The factors associated with falls were analyzed statistically.
A total of 32 patients experienced falls within 2 years. On univariate analysis, older age, osteoporosis, number of comorbid conditions and number of drugs were significantly associated with falls within 2 years. On multiple logistic regression analysis, the number of drugs was associated with falls, independent of age, sex, number of comorbid conditions and other factors that were significantly associated in univariate analysis. A receiver-operator curve evaluating the optimal cut-off value for the number of drugs showed that taking five or more drugs was a significant risk.
In geriatric outpatients, polypharmacy is associated with falls. Intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidity and falls.
在一项纵向观察研究中，调查导致老年人门诊患者跌倒的预测因素，如合并症和药物使用情况。
共评估了 172 名门诊患者（45 名男性和 126 名女性，平均年龄 76.9±7.0 岁）。每位患者在基线时接受体格检查、临床病史和药物使用情况评估。这些患者随访长达 2 年，跌倒情况由患者本人向医生报告。对与跌倒相关的因素进行了统计学分析。
共有 32 名患者在 2 年内发生跌倒。单因素分析显示，年龄较大、骨质疏松症、合并症数量和用药数量与 2 年内发生跌倒显著相关。多因素逻辑回归分析显示，药物使用数量与跌倒相关，独立于年龄、性别、合并症数量以及单因素分析中与跌倒显著相关的其他因素。评估药物使用数量的最佳截断值的受试者工作特征曲线显示，使用五种或更多药物是一个显著的风险因素。
在老年门诊患者中，多种药物治疗与跌倒有关。需要干预性研究来阐明多种药物治疗、合并症和跌倒之间的因果关系。
