Background and Importance Polypharmacy and falls are associated with increased morbidity and mortality, most of which are preventable.1
Aim and Objectives To identify the association between grade of polypharmacy and falls, and to obtain an index that allows rapid selection of patients who consult for falls in Emergency Department(ED) and who could benefit from a medication review with the pharmacist to prevent new falls.
Material and Methods Retrospective observational study in which patients ≥75 years admitted to the ED codified as ‘fall’ in the period between 01/01/2022 and 31/07/2022 were selected. Patients without a confirmed fall were excluded. Analyzed characteristics:sex,age,previous falls,median number of drugs prescribed(polypharmacy[≥5 drugs];extreme polypharmacy[≥10 drugs]).Medication information was extracted from the first ED medical note.The main variable was the risk of falls regarding patient pharmacotherapy(FPc),calculated by obtaining a sum where each drug in the following groups contributed one point:tranquilisers-sedatives, diuretics, hypotensives, antiparkinsonians, antidepressants, opioids, neuroleptics, and first-generation antihistamines drugs. A value≥2 was classified as high fall risk(Downton-Scale).The secondary variables were the association between sex,age,previous falls, polypharmacy and high-FPc. Data were obtained from the electronic-medical records. Statistical methods employed were Chi-square-test, Cramer’s-V, and odds ratio(OR).IBM-SPSSv.26.
Results A total of 118 patients were selected.No patients were excluded.The 76.3%(90/118) were female, mean age 83.72 years(SD=6.12) and 48.3%(57/118) had previous falls.The median number of drugs prescribed was 9(IQR=6–11).The 84.7%(100/118) of patients had polypharmacy and 41.5%(49/118) had extreme-polypharmacy.Median FPc was 3(IQR=2–4) and 83.1%(98/118) were classified as high risk.Association between high-FPc and collected variables: no association with age or sex (p=0.6;p=0.9 respectively).Association with previous falls(p=0.028), polypharmacy(p<0.001) and extreme-polypharmacy(p=0.002) with insignificant intensity(Cramer’s-V=0.15), moderate intensity(Cramer’s-V=0.562) and low intensity(Cramer’s-V=0.289), respectively.The OR for high fall risk was 23 times higher for polypharmacy patients, and 8 times higher in extreme-polypharmacy patients.
Conclusion and Relevance There is an association between polypharmacy and falls. Most patients had polypharmacy and were also classified as high fall risk with our index tool. There seem to be no major differences between having 5 or 10 drugs. Patients with a history of falls seem to have a higher probability of having a new fall.Our pharmacological stratification tool seems to associate positively high fall risk with polypharmacy.
Ziere G, Dieleman JP, Hofman A, Pols HAP, Van Der Cammen TJM, BHC. Polypharmacy and falls in the middle age and elderly population. BJCP 2006; 61:218–223. https://doi.org/10.1111/j.1365-2125.2005.02543.x
Conflict of Interest No conflict of interest
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