Association between polypharmacy and falls in older adults: a longitudinal study from England
Objectives Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.Design Longitudinal cohort study.Setting...
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BMJ Publishing Group
2017-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/7/10/e016358.full |
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| author | Nafeesa N Dhalwani Melanie J Davies Kamlesh Khunti Harini Sathanapally Radia Fahami Sam Seidu |
| author_facet | Nafeesa N Dhalwani Melanie J Davies Kamlesh Khunti Harini Sathanapally Radia Fahami Sam Seidu |
| author_sort | Nafeesa N Dhalwani |
| collection | DOAJ |
| description | Objectives Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.Design Longitudinal cohort study.Setting The English Longitudinal Study of Ageing waves 6 and 7.Participants 5213 adults aged 60 or older.Main outcome measures Rates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.Results A total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9–2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67).Conclusions We found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered. |
| format | Article |
| id | doaj-art-acaa7fbfefc248a4895f4cbe9dd079f4 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2017-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-acaa7fbfefc248a4895f4cbe9dd079f42025-02-11T13:50:10ZengBMJ Publishing GroupBMJ Open2044-60552017-10-0171010.1136/bmjopen-2017-016358Association between polypharmacy and falls in older adults: a longitudinal study from EnglandNafeesa N Dhalwani0Melanie J Davies1Kamlesh Khunti2Harini Sathanapally3Radia Fahami4Sam Seidu5Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK3 Leicester Diabetes Research Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UKprofessor5 NIHR Applied Research Collaboration East Midlands, University Hospitals of Leicester NHS Trust, Leicester, UKDepartment of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UKDepartment of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UKObjectives Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.Design Longitudinal cohort study.Setting The English Longitudinal Study of Ageing waves 6 and 7.Participants 5213 adults aged 60 or older.Main outcome measures Rates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.Results A total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9–2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67).Conclusions We found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.https://bmjopen.bmj.com/content/7/10/e016358.full |
| spellingShingle | Nafeesa N Dhalwani Melanie J Davies Kamlesh Khunti Harini Sathanapally Radia Fahami Sam Seidu Association between polypharmacy and falls in older adults: a longitudinal study from England BMJ Open |
| title | Association between polypharmacy and falls in older adults: a longitudinal study from England |
| title_full | Association between polypharmacy and falls in older adults: a longitudinal study from England |
| title_fullStr | Association between polypharmacy and falls in older adults: a longitudinal study from England |
| title_full_unstemmed | Association between polypharmacy and falls in older adults: a longitudinal study from England |
| title_short | Association between polypharmacy and falls in older adults: a longitudinal study from England |
| title_sort | association between polypharmacy and falls in older adults a longitudinal study from england |
| url | https://bmjopen.bmj.com/content/7/10/e016358.full |
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