Turner Justin P, Tervonen Hanna E, Shakib Sepehr, Singhal Nimit, Prowse Robert, Bell J Simon
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
J Eval Clin Pract. 2017 Apr;23(2):361-368. doi: 10.1111/jep.12624. Epub 2016 Aug 24.
Older people with cancer are at increased risk of falling. Falls risk-increasing drugs (FRIDs), comprising psychotropics and medications that cause orthostatic hypotension, are a potentially modifiable risk factor for falls. The objective of this study was to determine the prevalence and factors associated with use of FRIDs in older people with cancer. Patients aged ≥70 years who presented to a hospital outpatient clinic between January 2009 and July 2010 were included in the study. Information on current medication use, falls in previous 6 months, and frailty criteria was collected. Multinomial logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CIs) for factors associated with levels of FRID use. Overall, 76.1% (n = 293) of 383 patients used FRIDs. This comprised psychotropics (31.2%, n = 120) and medications causing orthostatic hypotension (69.9%, n = 269). In total, 24.0% (n = 92) patients reported falling in the previous 6 months. Risk factors for falling were associated with use of psychotropics but not orthostatic hypotension drugs. Patients with a history of falls had increased odds of using psychotropics (≥3 psychotropics; OR 13.50; 95%CI, 2.64-68.94). Likewise, frail patients had increased odds of using psychotropics (≥3 psychotropics; OR 27.78; 95%CI, 6.06-127.42). Risk factors for falling were associated with the use of psychotropics. This suggests that clinicians either do not recognize or underestimate the contribution of medications to falls in this high-risk patient group. Further efforts are needed to rationalize medication regimens at the time of patients' first presentation to outpatient oncology services.
老年癌症患者跌倒风险增加。增加跌倒风险的药物（FRIDs），包括精神药物和引起体位性低血压的药物，是跌倒的一个潜在可改变风险因素。本研究的目的是确定老年癌症患者中FRIDs的使用患病率及相关因素。纳入2009年1月至2010年7月在医院门诊就诊的≥70岁患者。收集当前用药情况、过去6个月内的跌倒情况及衰弱标准等信息。采用多项逻辑回归计算与FRID使用水平相关因素的比值比（OR）和95%置信区间（CIs）。总体而言，383例患者中有76.1%（n = 293）使用了FRIDs。其中包括精神药物（31.2%，n = 120）和引起体位性低血压的药物（69.9%，n = 269）。共有24.0%（n = 92）的患者报告在过去6个月内有跌倒。跌倒风险因素与精神药物的使用有关，而与体位性低血压药物无关。有跌倒史的患者使用精神药物的几率增加（≥3种精神药物；OR 13.50；95%CI，2.64 - 68.94）。同样，衰弱患者使用精神药物的几率增加（≥3种精神药物；OR 27.78；95%CI，6.06 - 127.42）。跌倒风险因素与精神药物的使用有关。这表明临床医生要么没有认识到要么低估了药物对这一高危患者群体跌倒的影响。在患者首次就诊肿瘤门诊时，需要进一步努力使药物治疗方案合理化。
