Association of fall risk-increasing drugs with falls in generally healthy older adults: a 3-year prospective observational study of the DO-HEALTH trial.

IF 3.4 2区 医学 Q2 GERIATRICS & GERONTOLOGY
Caroline de Godoi Rezende Costa Molino, Catherine K Forster, Maud Wieczorek, E John Orav, Reto W Kressig, Bruno Vellas, Andreas Egli, Gregor Freystaetter, Heike A Bischoff-Ferrari
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引用次数: 0

Abstract

Background: The association between fall risk-increasing drugs (FRIDs, medications known to be associated with falls) and the number of falls among generally healthy and active community-dwelling older adults is understudied. Prior studies have focused on individual medication classes or have predominantly relied on retrospective assessments of falls. The aim of this study was to investigate the association between FRID use at baseline and the prospective incidence rates of total, injurious and recurrent falls in community-dwelling older adults.

Methods: This is a 3-year observational analysis of DO-HEALTH, a randomized controlled trial, among community-dwelling adults aged ≥ 70 years without major diseases at baseline. The main exposures were use of at least one FRID and multiple FRIDs (≥ 2 FRIDs) at baseline. The number of total falls (including high- and low-trauma falls, as well as injurious falls) over 3 years of follow-up was defined as the primary outcome, and the number of injurious and the number of recurrent total falls (≥ 2 falls), as the two separate secondary outcomes. To examine these associations, separate negative binomial regression models controlled for the fixed effects of treatment allocation in the DO-HEALTH trial, study site, fall in the last year, age, sex, BMI, and walking aid were used. Additionally, an offset of the logarithm of each participant's time in the study was included in the models.

Results: A total of 2157 participants were included, with a baseline median age of 74.0 years, 61.7% of whom were women, and 41.9% having experienced a prior fall in the year preceding enrolment. At baseline, 908 (42.1%) participants used at least one FRID, and 351 (16.3%) reported multiple FRIDs use. Prospectively, over 3 years of follow-up, 3333 falls were reported by 1311 (60.8%) out of the 2157 participants. Baseline use of at least one FRID was significantly associated with increased incidence rates of total falls (incidence rate ratio (IRR) [95% Confidence Interval (CI)] = 1.13 [1.01-1.27]), injurious falls (IRR = 1.15 [1.02-1.29]), and recurrent falls (IRR = 1.12 [1.01-1.23]) over 3 years. These associations were most pronounced among users of multiple FRIDs, with increased incidence rates of total falls (IRR = 1.22 [1.05-1.42]), injurious falls (IRR = 1.33 [1.14-1.54]) and recurrent falls (IRR = 1.14 [1.02-1.29]).

Conclusion: Our results suggest that FRID use is associated with increased prospective incidence rates of total, injurious, and recurrent falls even among generally healthy older adults.

Trial registration: DO-HEALTH is registered as NCT01745263 on clinicaltrials.gov, with a registration date of 2012-12-06.

在一般健康的老年人中,增加跌倒风险的药物与跌倒的关联:一项为期3年的DO-HEALTH试验的前瞻性观察研究
背景:在一般健康和活跃的社区老年人中,增加跌倒风险的药物(frid,已知与跌倒相关的药物)与跌倒次数之间的关系尚未得到充分研究。先前的研究主要集中在个体药物类别上,或者主要依赖于对跌倒的回顾性评估。本研究的目的是调查基线时使用FRID与社区居住老年人总跌倒、伤害性跌倒和复发性跌倒的预期发生率之间的关系。方法:这是一项为期3年的DO-HEALTH观察性分析,一项随机对照试验,在基线时无重大疾病的≥70岁社区居民中进行。主要暴露是在基线时使用至少一个FRID和多个FRID(≥2个FRID)。在3年的随访中,总跌倒次数(包括高创伤性和低创伤性跌倒,以及伤害性跌倒)被定义为主要结局,而伤害性跌倒次数和复发性总跌倒次数(≥2次跌倒)被定义为两个单独的次要结局。为了检验这些关联,使用了单独的负二项回归模型,控制了DO-HEALTH试验中治疗分配、研究地点、去年跌倒、年龄、性别、BMI和助行器的固定效应。此外,每个参与者在研究中的时间的对数的偏移量被包括在模型中。结果:共纳入2157名参与者,基线中位年龄为74.0岁,其中61.7%为女性,41.9%在入组前一年经历过跌倒。基线时,908名(42.1%)参与者至少使用一种FRID, 351名(16.3%)参与者报告使用多种FRID。在3年的随访中,2157名参与者中有1311人(60.8%)报告了3333例跌倒。基线使用至少一种FRID与3年内总跌倒(发病率比(IRR)[95%可信区间(CI)] = 1.13[1.01-1.27])、伤害性跌倒(IRR = 1.15[1.02-1.29])和复发性跌倒(IRR = 1.12[1.01-1.23])发生率增加显著相关。这些关联在多重frid使用者中最为明显,总跌倒(IRR = 1.22[1.05-1.42])、伤害性跌倒(IRR = 1.33[1.14-1.54])和复发性跌倒(IRR = 1.14[1.02-1.29])的发生率增加。结论:我们的研究结果表明,即使在一般健康的老年人中,FRID的使用也与总体、损伤性和复发性跌倒的预期发生率增加有关。试验注册:DO-HEALTH在clinicaltrials.gov上注册为NCT01745263,注册日期为2012-12-06。
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来源期刊
BMC Geriatrics
BMC Geriatrics GERIATRICS & GERONTOLOGY-
CiteScore
5.70
自引率
7.30%
发文量
873
审稿时长
20 weeks
期刊介绍: BMC Geriatrics is an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. The journal also welcomes research focused on the aging process, including cellular, genetic, and physiological processes and cognitive modifications.
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