Ie Kenya, Chou Eric, Boyce Richard D, Albert Steven M
Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.
Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Japan.
Innov Aging. 2021 Jan 8;5(1):igab001. doi: 10.1093/geroni/igab001. eCollection 2021.
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.
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).
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.
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.
药物暴露是老年人跌倒、随后死亡以及功能衰退的一个潜在风险因素。然而，在评估药物暴露的最佳方法以及哪种方法能最好地预测跌倒方面仍存在争议。本研究的目的是探讨社区居住的老年人中不同药物暴露测量指标与跌倒风险之间的关联。
本回顾性队列研究使用了“宾夕法尼亚州无跌倒计划”的数据以及来自宾夕法尼亚州老年人药物援助合同的关联处方索赔数据。参与者为居住在美国宾夕法尼亚州的社区老年人。评估了三种药物暴露测量指标：（a）常规药物总数（多重用药）；（b）根据当前处方指导工具得出的潜在不适当药物数量（跌倒风险增加药物[FRIDs]，Beers标准）；（c）基于药理机制的药物负担指数（抗胆碱能认知负担、药物负担指数），所有这些均来自索赔数据。使用单变量和多变量负二项回归模型检验不同药物风险测量指标与自我报告的跌倒发生率之间的关联，以估计发病率比（IRRs）。
总共纳入了343名老年人，在2316个活动调整人月期间有236个月发生跌倒（每100个活动调整人月有10.2次跌倒）。在多变量模型中评估的6种药物风险测量指标中，只有使用2种或更多FRIDs（调整后的IRR为1.67[95%CI：1.04 - 2.68]）能独立预测跌倒风险。在13种FRID药物类别中，唯一与跌倒风险增加相关的FRID类别是抗抑郁药。
处方中存在多种FRIDs是跌倒的独立风险因素，即使在用药较少的老年人中也是如此。需要进一步研究以检验针对FRIDs的减药是否能有效预防该人群的跌倒。
