College of Pharmacy, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936, Republic of Korea.
Gachon Institute of Pharmaceutical Sciences, Incheon, Republic of Korea.
BMC Geriatr. 2024 Aug 23;24(1):699. doi: 10.1186/s12877-024-05300-x.
Potentially inappropriate medications (PIMs) are prevalent in older adults with dementia and subsequent falls or fall-related injuries. The present study determined the risk of falls or fall-related injuries associated with PIM use in older adults with dementia.
The National Health Insurance Service-Elderly Cohort Database 2.0 (NHIS-ECDB 2.0) was used for this self-controlled case series (SCCS) study. This study included 1430 participants who went through exposure and non-exposure periods of PIM application among patients with dementia and experienced outcome events of falls or fall-related injuries between January 2016 and December 2019. The incidence of falls or fall-related injuries during the exposure and post-exposure periods was compared with that during the non-exposure period. Beers Criteria were used to define PIMs in patients with dementia. Negative binomial regression was conducted. The incidence rate ratio (IRR) was used to determine the risk of falls or fall-related injuries.
During the exposure periods in which falls or fall-related injuries occurred, the mean number of PIMs among patients with dementia was 3.76 (SD = 2.99), and the most commonly used PIMs among patients with dementia were first-generation antihistamines (n = 283; 59.1%). Compared to the non-exposure period, the adjusted IRR during the exposure period was 1.57 (95% CI = 1.39-1.76). The risk of falls or fall-related injuries was increased when PIM use in patients with dementia was initiated (1-14 days: IRR = 2.76, 95% CI = 2.31-3.28; 15-28 days: IRR = 1.95, 95% CI = 1.48-2.56; ≥ 29 days: IRR = 1.17, 95% CI = 1.01-1.35). Especially, an increased risk of falls or fall-related injuries was associated with greater PIM use among patients with dementia.
Among older adults with dementia, PIMs significantly increase the risk of falls and fall-related injuries. Therefore, strategies should be developed to manage PIM prescriptions in patients with dementia to prevent falls.
在患有痴呆症的老年人中，潜在不适当药物（PIMs）很常见，随后会发生跌倒或与跌倒相关的伤害。本研究旨在确定患有痴呆症的老年人使用 PIM 与跌倒或与跌倒相关的伤害之间的关联风险。
本研究使用了国家健康保险服务-老年人队列数据库 2.0（NHIS-ECDB 2.0）进行了这项自我对照病例系列（SCCS）研究。该研究纳入了 1430 名参与者，他们在患有痴呆症的患者中经历了 PIM 应用的暴露期和非暴露期，并在 2016 年 1 月至 2019 年 12 月期间发生了跌倒或与跌倒相关的伤害的结局事件。比较了暴露期和暴露后期间与非暴露期期间跌倒或与跌倒相关的伤害的发生率。使用 Beers 标准来定义痴呆症患者中的 PIMs。采用负二项式回归分析，使用发病率比（IRR）来确定跌倒或与跌倒相关的伤害的风险。
在发生跌倒或与跌倒相关的伤害的暴露期期间，痴呆症患者的 PIM 平均数量为 3.76（标准差=2.99），痴呆症患者中最常用的 PIM 是第一代抗组胺药（n=283；59.1%）。与非暴露期相比，暴露期的调整后 IRR 为 1.57（95%CI=1.39-1.76）。当痴呆症患者开始使用 PIM 时，跌倒或与跌倒相关的伤害的风险会增加（1-14 天：IRR=2.76，95%CI=2.31-3.28；15-28 天：IRR=1.95，95%CI=1.48-2.56；≥29 天：IRR=1.17，95%CI=1.01-1.35）。特别是，痴呆症患者 PIM 使用量增加与跌倒或与跌倒相关的伤害的风险增加相关。
在患有痴呆症的老年人中，PIM 显著增加跌倒和与跌倒相关的伤害的风险。因此，应制定策略来管理痴呆症患者的 PIM 处方，以预防跌倒。
