gms | German Medical Science

28th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

11.11. - 12.11.2021, digital

Risk of fall injuries while taking hypnotics, antidepressants, and analgesics

Meeting Abstract

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 28. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. sine loco [digital], 11.-12.11.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc21gaa11

doi: 10.3205/21gaa11, urn:nbn:de:0183-21gaa112

Published: November 10, 2021

© 2021 Oehler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Background: Little research exists on the cumulative effect of simultaneously used medicines that may increase the risk of falls. A promising approach is the definition of scores to characterise the overall risk of specific Fall Risk Increasing Adverse Reactions (FRIARs).

Problem: Can FRIAR scores for (1) “visual disorders,” (2) “vertigo,” (3) “vigilance disorder,” (4) “hypotension,” (5) “weakness,” and (6) “tendency to fall” based on the Summary of Product Characteristics (SPC) map the cumulative drug-related risk of fall injuries?

Materials and Methods: The data source is anonymized population-based data from the Tayside/Fife region of Scotland, UK (HIC database). A nested case-control study was conducted based on the cohort of ≥65-year-old patients in the HIC database. Cases are defined as patients hospitalized for fall injuries (i.e., fractures of the limb, shoulder girdle, and pelvic girdle). Controls are matched by sex, age, and date of cohort entry. FRIAR scores correspond to the number of simultaneously prescribed agents for which the respective FRIAR is listed as an adverse event in the SPC. The FRIAR scores are calculated for cases and controls, respectively, in the time window three months before the incidence date. The risk of fall injuries associated with the FRIAR scores is quantified using conditional logistic regression.

Results: A total of 13,734 cases and matched controls were included. Multivariate analyses showed that the risk of fall injuries increased in parallel with the score, particularly for the FRIAR scores (3) “vigilance disorder” (odds ratio (OR) for FRIAR score ≥2 vs. 0: 1.33 (95% CI 1.27–1.38)) and (6) “tendency to fall” (OR 1.26 (95% CI 1.19–1.34)). In comparison, the association with the number of drugs established as FRIDs in the literature appeared to be lower.

Conclusion: The study suggests that FRIAR scores based on the SPC can map the cumulative drug-related risk of fall injuries and are superior in this regard to identifying drugs established as FRIDs. FRIAR scores based on the SPC have the potential to guide medication optimization to minimize the risk of fall injuries.