Clarkson Louise, Griffiths Anthony, Ng Shu-Kay, Lam Alfred K, Khoo Tien K
School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.
Northern New South Wales Local Health District, Lismore, NSW, Australia.
Int J Clin Pharm. 2025 Feb 7. doi: 10.1007/s11096-024-01859-y.
Falls in older adults might increase due to polypharmacy.
This study aimed to explore the association between preadmission medications and history of falls in older inpatients.
This observational study of inpatients aged ≥ 65 years was conducted over 4 years at Ballina Hospital, Australia. The Medication Regimen Complexity Index (MRCI), Drug Burden Index (DBI), and Anticholinergic Effect on Cognition (AEC) scores were calculated for preadmission medications. Polypharmacy and falls questionnaires were administered to identify falls in the past 6 months and aptitude toward medication use.
Overall, 194 participants with a mean age of 80.2 (SD 8.0) years were included. The mean daily number of regular medications was 7.8 (SD 3.9) and the mean MRCI score was 22 (SD 12.6). Among the participants, 107 (55%) reported falls in the past 6 months and 47 (24%) reported ≥ 2 falls. Age and hearing impairment were positively associated with falls (p = 0.007 and p = 0.003, respectively). History of falls was positively associated with a MRCI score of ≥ 20 (p = 0.018), an AEC score of ≥ 2 (p = 0.010) and a DBI score of ≥ 1 after adjustment for age (p = 0.041). Forgetting medications was associated with falls (p = 0.043). Antihypertensive use did not increase falls risk.
Implementing a decisive approach to simplify complex medication regimens, along with patient-focused medication management strategies, may help reduce the risk of falls in older adults. Sedatives and anticholinergic medications increase the risk of falls and should be avoided whenever possible.
多重用药可能会增加老年人跌倒的风险。
本研究旨在探讨老年住院患者入院前用药与跌倒史之间的关联。
在澳大利亚巴利纳医院对年龄≥65岁的住院患者进行了为期4年的观察性研究。计算入院前用药的药物治疗方案复杂性指数（MRCI）、药物负担指数（DBI）和抗胆碱能认知效应（AEC）得分。采用多重用药和跌倒问卷来确定过去6个月内的跌倒情况以及用药倾向。
共纳入194名参与者，平均年龄为80.2（标准差8.0）岁。常规药物的平均每日服用数量为7.8（标准差3.9），平均MRCI得分为22（标准差12.6）。在参与者中，107人（55%）报告在过去6个月内有跌倒情况，47人（24%）报告跌倒≥2次。年龄和听力障碍与跌倒呈正相关（分别为p = 0.007和p = 0.003）。在对年龄进行调整后，跌倒史与MRCI得分≥20（p = 0.018）、AEC得分≥2（p = 0.010）以及DBI得分≥1呈正相关（p = 0.041）。忘记服药与跌倒有关（p = 0.043）。使用抗高血压药物并未增加跌倒风险。
实施果断措施简化复杂的药物治疗方案，同时采用以患者为中心的药物管理策略，可能有助于降低老年人跌倒的风险。镇静剂和抗胆碱能药物会增加跌倒风险，应尽可能避免使用。
