gms | German Medical Science

Background: A wide range of evidence exists on the association of polypharmacia and the risk of falls. According to a metaanalysis by Woolcott et al. (2009), the medication groups of psycholeptics, psychoanaleptics, non-steroidal anti-inflammatory drugs and antihypertensives drugs increase the risk of falls . The aim of this study was to investigate the relationship between fall risk increasing drugs (FRIDS) and the risk of falls in regard to fall-related chronic diseases.

Materials and Methods: In total, 39 primary care physicians in Germany participated in the EvaMed Pharmacovigilance Network. Data were transferred to the EvaMed Documentation server including an exact time stamp. Antihypertensives, non-steroidal anti-inflammatory drugs, hypnotics and sedatives, antidepressants and psycholeptics were labelled as FRIDS. A fall was defined according to a diagnosis in the chapter Injury or poisoning (S00-T14 in International Statistical Classification of Diseases 10th Revision (ICD-10)). Patients older than or equal to 65 years with at least two doctor’s visits were included.

Data analysis was performed in ‘R: A Language and Environment for Statistical Computing’ (ver. 2.15.1, R Development Core Team 2012).

Results: From a total of 5124 patients included in the analysis, FRIDS were prescribed for 1768 patients. From patients (N=425) with at least one diagnosis of fall, 219 patients were prescribed FRIDS. In 100 (45.7%) of cases the diagnoses for fall were made before and in 105 (47.9%) of cases at least a month after the prescription of FRIDS. 14 (6.4%) patients had a prescription of FRIDS and a diagnosis of fall within one month.

Comparing patients with a diagnosis fall, patients prescribed a FRIDS (n=219) were significantly older (75.5 years, CI 74.3-76.7) than patients without a FRIDS prescription (73.5 years, CI 72.3-74.7). More females, (n=161, 55.7%) than males (58, 42.6%) received FRIDS.

Logistic regression models were conducted testing age and sex, chronic diseases and FRIDS as independent risk factor for falls. Age and 10 out of 19 diagnoses were significantly associated with falls. Including FRIDS in the final model, patients being prescribed FRIDS had a 70% increased risk experiencing a fall. Besides FRIDS, diseases associated with balance (vertigo, visual impairment, abnormalities of gait and mobility), gait speed (weight loss and heart diseases) and pain from a degenerative disease (arthritis) remained as independent risk factors.

Conclusion: Perceptual disorders, low walking speed and pain are prominent predictors for falls in the elderly. A prescription of FRIDS selects more vulnerable patients having a higher risk of falls, regardless whether the prescription was before or after the fall. However, experiencing a fall is mainly due to the disease followed by treatment. Thus, not prescribing FRIDS will avoid only a small number of falls.