Helgadóttir Björg, Laflamme Lucie, Monárrez-Espino Joel, Möller Jette
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
BMC Geriatr. 2014 Aug 23;14:92. doi: 10.1186/1471-2318-14-92.
The simultaneous use of several medications is an important risk factor for injurious falls in older people. The aim of this study is to investigate the effect of the number of medications dispensed to elderly persons on fall injuries and to assess whether this relationship is explained by individual demographics, health habits and health status.
A population-based, nested, case-control study on people 65 years and older (N = 20.906) was conducted using data from the Stockholm Public Health Cohort (SPHC) derived from self-administered surveys and linked at the individual level with various Swedish health registers. Fall injuries leading to hospitalization recorded in the Swedish National Patient Register (NPR) were considered as the outcome. The main exposure, obtained from the Swedish Prescribed Drug Register (SPDR), was the number of medications dispensed within 90 days prior to the injurious fall. The injury risk was estimated using adjusted odds ratios (ORs) from logistic regression. Results were adjusted by selected demographic, social circumstances, lifestyle and health status data extracted from the SPHC.
After adjusting for common risk factors within demographics, lifestyle, social circumstances and health status, using more than one medication increased the risk of fall injury but no clear dose-response relationship was observed, with point estimates ranging from 1.5-1.7 for the use of two, three, four or five or more medications as compared to using none. An increased risk remained, and was even elevated, after adjusting for the use of fall-risk-increasing drugs (FRIDs).
Using more than one medication affects the risk of injurious falls among older people. The effect of any given number of medications studied remains and is even strengthened after adjusting for individual demographics, health habits, health conditions and the use of FRIDs.
同时使用多种药物是老年人发生跌倒致伤的一个重要危险因素。本研究旨在调查给老年人配药数量对跌倒致伤的影响，并评估这种关系是否可由个体人口统计学特征、健康习惯和健康状况来解释。
利用斯德哥尔摩公共卫生队列（SPHC）的数据进行了一项基于人群的巢式病例对照研究，研究对象为65岁及以上人群（N = 20906）。该队列数据来自自我管理的调查，并在个体层面与瑞典的各种健康登记册相链接。瑞典国家患者登记册（NPR）中记录的因跌倒致伤而住院的情况被视为研究结果。主要暴露因素来自瑞典处方药登记册（SPDR），即跌倒致伤前90天内配药的数量。使用逻辑回归的调整比值比（OR）来估计受伤风险。结果根据从SPHC中提取的选定人口统计学、社会环境、生活方式和健康状况数据进行了调整。
在对人口统计学、生活方式、社会环境和健康状况中的常见风险因素进行调整后，使用一种以上药物会增加跌倒致伤的风险，但未观察到明确的剂量反应关系，与未使用药物相比，使用两种、三种、四种或五种及以上药物的点估计值在1.5至1.7之间。在对使用增加跌倒风险药物（FRIDs）进行调整后，风险仍然增加，甚至更高。
使用一种以上药物会影响老年人跌倒致伤的风险。在对个体人口统计学特征、健康习惯、健康状况以及使用FRIDs进行调整后，所研究的任何给定数量药物的影响仍然存在，甚至有所增强。
