Department of Pharmacy Practice, College of Pharmacy, Midwestern University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA.
Present address: Banner - University Medicine Diabetes and Endocrinology Institute, Phoenix, AZ, 85006, USA.
BMC Geriatr. 2019 Jul 19;19(1):194. doi: 10.1186/s12877-019-1202-3.
Injurious falls among older adults are both common and costly. The prevalence of falls is known to increase with age and with use of fall-risk drugs/potentially inappropriate medications (FRD/PIM). Little is known about the joint effects of these two risk factors.
Data for 2013-2015 were obtained from the Truven Health MarketScan® Medicare database comprising utilization and eligibility (enrollment) data for approximately 4 million enrollees annually. A case-control design was used to compare enrollees aged 65-99 years diagnosed with > 1 fall event (n = 110,625) with enrollees without falls (n = 1,567,412). An exploratory analysis of joint age-FRD/PIM effects on fall risks was based on number needed to harm (NNH) calculations for each FRD/PIM therapy class count (compared with 0 FRD/PIMs), stratified by age group. Logistic regression analyses adjusted for demographics, comorbidities, and fracture history, measured in the 1 year prior to the fall date (cases) or a randomly assigned date (controls).
For each FRD/PIM class count, NNH values decreased with older age (e.g., for 1 FRD/PIM class: from NNH = 333 for ages 65-74 years to NNH = 83 for ages 90-99 years; for 2 FRD/PIM classes: from NNH = 91 for ages 65-74 years to NNH = 38 for ages 90-99 years). NNH decreased to < 15 patients at > 6 classes for age 65-74 years, > 5 classes for age 75-84 years, and > 4 classes for age 85-99 years. Adjusted odds of falling were increased for age-FRD/PIM combinations with smaller NNH values: adjusted odds ratio (AOR) = 1.127 (95% confidence interval [CI] = 1.098-1.156) for NNH = 83-91; AOR = 1.427 (95% CI = 1.398-1.456) for NNH = 17-48; AOR = 1.983 (1.9034-2.032) for NNH < 15.
FRD/PIM use and age appear to have joint effects on fall risk. Older adults at high risk, indicated by small NNH, may be appropriate for fall prevention initiatives, and clinicians may wish to consider decreasing the number of FRD/PIMs utilized by these patients.
老年人受伤性跌倒既常见又昂贵。随着年龄的增长和使用跌倒风险药物/潜在不适当药物（FRD/PIM），跌倒的发生率是已知的。关于这两个危险因素的联合效应知之甚少。
2013-2015 年的数据来自 Truven Health MarketScan® Medicare 数据库，该数据库包含每年约 400 万参保人的使用情况和资格（注册）数据。采用病例对照设计比较了 2013-2015 年被诊断为> 1 次跌倒事件的 65-99 岁参保者（n=110625）与无跌倒的参保者（n=1567412）。基于每个 FRD/PIM 治疗类别计数（与 0 个 FRD/PIM 相比）的伤害需要数（NNH）计算，对年龄-FRD/PIM 联合效应进行了探索性分析，按年龄组分层。使用在跌倒日期（病例）或随机指定日期（对照）前 1 年测量的人口统计学、合并症和骨折史，对 logistic 回归分析进行了调整。
对于每个 FRD/PIM 类别计数，NNH 值随年龄增长而降低（例如，对于 1 个 FRD/PIM 类别：NNH=333 岁，年龄为 65-74 岁，NNH=83 岁，年龄为 90-99 岁；对于 2 个 FRD/PIM 类别：NNH=91 岁，年龄为 65-74 岁，NNH=38 岁，年龄为 75-84 岁）。对于 65-74 岁年龄组，NNH 降至> 6 类<15 例，75-84 岁年龄组> 5 类<15 例，85-99 岁年龄组> 4 类<15 例。与 NNH 值较小的年龄-FRD/PIM 组合相比，跌倒的校正优势比（AOR）更高：NNH=83-91 时，AOR=1.127（95%置信区间[CI]：1.098-1.156）；NNH=17-48 时，AOR=1.427（95%CI：1.398-1.456）；NNH<15 时，AOR=1.983（1.9034-2.032）。
FRD/PIM 的使用和年龄似乎对跌倒风险有共同影响。风险较高的老年人，用较小的 NNH 表示，可能适合预防跌倒的措施，临床医生可能希望考虑减少这些患者使用的 FRD/PIM 数量。
