Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Geriatr Gerontol Int. 2022 Oct;22(10):857-864. doi: 10.1111/ggi.14473. Epub 2022 Sep 2.
This matched case-control study investigated potentially inappropriate medication (PIM) use, polypharmacy, and other potential risk factors for falls among hospitalized older adults in Taiwan.
During an 18-month study period, 131 case patients who experienced a fall during hospitalization in an acute-care hospital were identified and matched by the time of day, hospital ward, and age to controls (five for each case) who were selected through random systematic sampling. Data on demographics, medical characteristics, and all orally and intravascularly administered medications during hospitalization prior to a fall were collected. PIMs were assessed using the 2019 Beers criteria.
A conditional logistic regression analysis revealed that admission to the departments of internal medicine (odds ratio [OR] = 2.33; 95% confidence interval [CI] = 1.09-4.91) and neurology and rehabilitation (OR = 4.67; 95% CI = 2.08-10.5), diabetes with end-organ damage (OR = 2.07; 95% CI = 1.11-3.86), PIM use of central nervous system drugs (OR = 1.81; 95% CI = 1.15-2.86), use of colchicine (OR = 5.49; 95% CI = 1.34-22.5) and spironolactone (OR = 4.54; 95% CI = 1.31-15.8) for renal function impairment, and polypharmacy (≥5 medications; OR = 1.81; 95% CI = 1.05-3.10) significantly increased the risk of falls. By contrast, being overweight or obese (OR = 0.47; 95% CI = 0.29-0.78) was associated with a significantly lower risk of falls.
PIM use may increase the risk of falls in hospitalized older patients, and PIM identification and evaluation can reduce this risk. Geriatr Gerontol Int 2022; 22: 857-864.
本匹配病例对照研究旨在调查中国台湾地区住院老年患者潜在不适当用药（PIM）、多重用药和其他跌倒相关潜在风险因素。
在 18 个月的研究期间，我们确定了 131 名在急性护理医院住院期间发生跌倒的病例患者，并通过时间、医院病房和年龄与通过随机系统抽样选择的对照组（每个病例 5 名）进行匹配。收集了人口统计学、医疗特征以及跌倒前住院期间所有口服和静脉内给予的药物数据。使用 2019 年 Beers 标准评估 PIM。
条件逻辑回归分析显示，内科（优势比 [OR] = 2.33；95%置信区间 [CI] = 1.09-4.91）和神经科与康复科（OR = 4.67；95% CI = 2.08-10.5）、有终末器官损伤的糖尿病（OR = 2.07；95% CI = 1.11-3.86）、使用中枢神经系统药物的 PIM（OR = 1.81；95% CI = 1.15-2.86）、秋水仙碱（OR = 5.49；95% CI = 1.34-22.5）和螺内酯（OR = 4.54；95% CI = 1.31-15.8）导致肾功能损害，以及使用≥5 种药物的多重用药（OR = 1.81；95% CI = 1.05-3.10）显著增加跌倒风险。相比之下，超重或肥胖（OR = 0.47；95% CI = 0.29-0.78）与跌倒风险显著降低相关。
PIM 使用可能会增加住院老年患者跌倒的风险，而 PIM 的识别和评估可以降低这种风险。
