The Role of Fall Risk-Increasing Drugs in Prevalence of Fall and its Associated Factors
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Abstract
Introduction: The World Health Organization defines a fall as "an event where a person comes to rest inadvertently on the ground or another lower level”. Among numerous risk factors, medication use stands out as one of the most highly modifiable risk factors for falls in adults. Medications associated with an increased fall risk have been termed Fall Risk–Increasing Drugs (FRIDs). This study aimed to determine the prevalence of falls among patients at Hospital Baling and its associated factors. Methods: A cross-sectional study was conducted by examining patients' history of falls and medication records for those admitted to the ward from 1st January to 30th June 2023. Systematic random sampling was used, and multiple logistic regression was performed to determine the risk factors for falls. Types of FRIDs were extracted from the Comprehensive Falls Risk Assessment Instrument (FRAI) and scored based on prescribed medications. Results: A total of 200 medical records were examined. The prevalence of falls among patients was 10.5% whereby the mean FRAI score was 2.32. Patients using diuretics were 81% less likely to experience falls (adjusted OR = 0.19, 95% CI [0.04, 0.94], p = 0.038), while each additional comorbidity increased the odds of falling by 2.2 times (adjusted OR = 2.20, 95% CI [1.38, 3.51], p = 0.001). Conclusion: FRIDs, except for diuretics, did not show any significant association with falls. However, thorough medication review by pharmacists remains essential, despite FRIDs showing little to no difference in increasing risk of falls.
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References
Adams, C. M., Tancredi, D. J., Bell, J. F., Catz, S. L., & Romano, P. S. (2020). Associations between home injury falls and prior hospitalizations in community dwelling older adults: A population case-crossover study. Injury, 51(2), 260-266. https://doi.org/https://doi.org/10.1016/j.injury.2019.11.035
Alex, D., Khor, H. M., Chin, A. V., Hairi, N. N., Cumming, R. G., Othman, S., Khoo, S., Kamaruzzaman, S. B., & Tan, M. P. (2020). Factors Associated With Falls Among Urban-Dwellers Aged 55 Years and Over in the Malaysian Elders Longitudinal Research (MELoR) Study [Original Research]. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.506238
Appeadu, M., & Bordoni, B. (2023). Falls and fall prevention in older adults. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK560761/
Ariffin, W. N. (2024). Sample size calculator (web). Retrieved 24 April 2024 from http://wnarifin.github.io
Azidah, A. K., Hasniza, H., & Zunaina, E. (2012). Prevalence of Falls and Its Associated Factors among Elderly Diabetes in a Tertiary Center, Malaysia. Curr Gerontol Geriatr Res, 2012, 539073. https://doi.org/10.1155/2012/539073
Berdot, S., Bertrand, M., Dartigues, J. F., Fourrier, A., Tavernier, B., Ritchie, K., & Alpérovitch, A. (2009). Inappropriate medication use and risk of falls--a prospective study in a large community-dwelling elderly cohort. BMC Geriatr, 9, 30. https://doi.org/10.1186/1471-2318-9-30
Damián, J., Pastor-Barriuso, R., Valderrama-Gama, E., & de Pedro-Cuesta, J. (2013). Factors associated with falls among older adults living in institutions. BMC Geriatr, 13, 6. https://doi.org/10.1186/1471-2318-13-6
de Jong, M. R., Van der Elst, M., & Hartholt, K. A. (2013). Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf, 4(4), 147-154. https://doi.org/10.1177/2042098613486829
de Vries, M., Seppala, L. J., Daams, J. G., van de Glind, E. M., Masud, T., van der Velde, N., Blain, H., Bousquet, J., Bucht, G., & Caballero-Mora, M. A. (2018). Fall-risk-increasing drugs: a systematic review and meta-analysis: I. Cardiovascular drugs. Journal of the American Medical Directors Association, 19(4), 371. e371-371. e379. https://doi.org/10.1016/j.jamda.2017.12.013
Dunne, T. J., Gaboury, I., & Ashe, M. C. (2014). Falls in hospital increase length of stay regardless of degree of harm. J Eval Clin Pract, 20(4), 396-400. https://doi.org/10.1111/jep.12144
Dykes, P. C., Curtin-Bowen, M., Lipsitz, S., Franz, C., Adelman, J., Adkison, L., Bogaisky, M., Carroll, D., Carter, E., Herlihy, L., Lindros, M. E., Ryan, V., Scanlan, M., Walsh, M. A., Wien, M., & Bates, D. W. (2023). Cost of Inpatient Falls and Cost-Benefit Analysis of Implementation of an Evidence-Based Fall Prevention Program. JAMA Health Forum, 4(1), e225125. https://doi.org/10.1001/jamahealthforum.2022.5125
Ghazi, H. F., Elnajeh, M., Abdalqader, M. A., Baobaid, M. F., Rosli, N. S. R., & Syahiman, N. (2017). The prevalence of falls and its associated factors among elderly living in old folks home in Kuala Lumpur, Malaysia. International Journal of Community Medicine and Public Health, 4(10), 3524-3529. https://doi.org/https://doi.org/10.18203/2394-6040.ijcmph20174214
Green, S. B. (1991). How Many Subjects Does It Take To Do A Regression Analysis. Multivariate Behav Res, 26(3), 499-510. https://doi.org/10.1207/s15327906mbr2603_7
Hart, L. A., Phelan, E. A., Yi, J. Y., Marcum, Z. A., & Gray, S. L. (2020). Use of Fall Risk-Increasing Drugs Around a Fall-Related Injury in Older Adults: A Systematic Review. J Am Geriatr Soc, 68(6), 1334-1343. https://doi.org/10.1111/jgs.16369
James, S. L., Lucchesi, L. R., Bisignano, C., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., Henry, N. J., Krohn, K. J., Liu, Z., McCracken, D., Nixon, M. R., Roberts, N. L. S., Sylte, D. O., Adsuar, J. C., Arora, A., Briggs, A. M., Collado-Mateo, D., Cooper, C., . . . Murray, C. J. L. (2020). The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Injury Prevention, 26(Suppl 2), i3-i11. https://doi.org/10.1136/injuryprev-2019-043286
Kumar, R. (2015). Errors in use of multivariable regression analysis. Indian J Pharmacol, 47(5), 571-572. https://doi.org/10.4103/0253-7613.165187
Lee, J., Negm, A., Peters, R., Wong, E. K. C., & Holbrook, A. (2021). Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open, 11(2), e035978. https://doi.org/10.1136/bmjopen-2019-035978
Milos, N. V., Bondesson, A., Magnusson, M., Jakobsson, U., Westerlund, T., & Midlöv, P. (2014). Fall risk-increasing drugs and falls: A cross-sectional study among elderly patients in primary care. BMC geriatrics, 14, 40. https://doi.org/10.1186/1471-2318-14-40
Ministry of Health Malaysia. (2018). Reference Guide for Nurses in Prevention of Patient Fall. Ministry of Health Malaysia https://hq.moh.gov.my/nursing/wp-content/uploads/2018/05/1-Reference-Guide-For-Nurses-to-Prevent-Patient-Fall.pdf
Ministry of Health Malaysia. (2019). Fall Guideline For Hospitalised Older Adults In Ministry of Health. https://jknmelaka.moh.gov.my/hmelaka/images/borang/Patient%20Fall%20-%20KKM%20Guideline%202019.pdf
Morse, J. M., Morse, R. M., & Tylko, S. J. (1989). Development of a Scale to Identify the Fall-Prone Patient. Canadian Journal on Aging / La Revue canadienne du vieillissement, 8(4), 366-377. https://doi.org/10.1017/S0714980800008576
Pitchai, P., Dedhia, H. B., Bhandari, N., Krishnan, D., D'Souza, N. R. J., & Bellara, J. M. (2019). Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population - A descriptive study. Indian J Public Health, 63(1), 21-26. https://doi.org/10.4103/ijph.IJPH_332_17
Ramos, K. A., Colosimo, E. A., Duarte, Y. A. d. O., & Bof de Andrade, F. (2023). Effect of polypharmacy and Fall-Risk-Increasing Drugs (FRIDs) on falls among Brazilian older adults: The SABE cohort study. Archives of Gerontology and Geriatrics, 115, 105127. https://doi.org/https://doi.org/10.1016/j.archger.2023.105127
Rizawati, M., & Ayu, S. (2008). Home environment and fall at home among the elderly in Masjid Tanah Province. Journal of Health and Translational Medicine, 11, 72-82. https://doi.org/10.22452/jummec.vol11no2.6
Sahril, N., Shahein, N. A., Yoep, N., Mahmud, N. A., Sooryanarayana, R., Maw Pin, T., Muhamad, N. A., & Ismail, H. (2020). Prevalence and factors associated with falls among older persons in Malaysia. Geriatrics & Gerontology International, 20 Suppl 2, 33-37. https://doi.org/10.1111/ggi.13980
Seppala, L. J., Petrovic, M., Ryg, J., Bahat, G., Topinkova, E., Szczerbi?ska, K., van der Cammen, T. J., Hartikainen, S., Ilhan, B., & Landi, F. (2021). STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk): a Delphi study by the EuGMS task and finish group on fall-risk-increasing drugs. Age and Ageing, 50(4), 1189-1199. https://doi.org/10.1093/ageing/afaa249
Sibley, K. M., Voth, J., Munce, S. E., Straus, S. E., & Jaglal, S. B. (2014). Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions. BMC geriatrics, 14, 1-11. https://doi.org/10.1186/1471-2318-14-22.
Tinetti, M. E., Doucette, J., Claus, E., & Marottoli, R. (1995). Risk factors for serious injury during falls by older persons in the community. Journal of the American Geriatrics Society, 43(11), 1214-1221. https://doi.org/10.1111/j.1532-5415.1995.tb07396.x
World Health Organization. (2007). WHO Global Report on Falls Prevention in Older Age. https://extranet.who.int/agefriendlyworld/wp-content/uploads/2014/06/WHo-Global-report-on-falls-prevention-in-older-age.pdf
Yeong, U. Y., Tan, S., Yap, J., & Choo, W. (2016). Prevalence of falls among community-dwelling elderly and its associated factors: A cross-sectional study in Perak, Malaysia. Malaysian Family Physician, 11(1), 7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5405326/
Zia, A., Kamaruzzaman, S. B., & Tan, M. P. (2017). The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls. Geriatrics & Gerontology International, 17(3), 463-470. https://doi.org/10.1111/ggi.12741
Ziere, G., Dieleman, J. P., Hofman, A., Pols, H. A., van der Cammen, T. J., & Stricker, B. H. (2006). Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol, 61(2), 218-223. https://doi.org/10.1111/j.1365-2125.2005.02543.x