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Drugs and falls in older people in geriatric care settings.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2004 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 16, no 4, 270-276 p.Article in journal (Refereed) Published
Abstract [en]

ACKGROUND AND AIMS: Falls and their consequences constitute serious health problems in the older population. The aim was to study predisposing factors for falls among older people in geriatric care settings, focusing on drugs. METHODS: This population-based study, with a cross-sectional design, analysed all geriatric care settings, comprising 68 residential care facilities, 31 nursing homes, 66 group dwellings for people with dementia, seven rehabilitation/short-stay units, two somatic geriatric and two psychogeriatric clinics, in the county of Västerbotten; 3604 residents with a mean age of 83.3+/-7.0 (65-103) years (68% women) were included. The residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) that measures, for example, mobility, paresis, vision, hearing, functions of activities of daily living (ADL), and behavioural and psychiatric symptoms. Drug consumption and falls during the previous week were recorded. RESULTS: Three hundred and one residents (8.4%) had sustained a fall at least once during the preceding week. Multivariate analyses showed that a history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, and use of neuroleptics or antidepressants were all associated with being a faller. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) but not serotonin and noradrenalin reuptake inhibitors (SNRIs) were associated with falls. Cholinesterase inhibitors were not associated with falls. CONCLUSIONS: Like functional and cognitive impairment, treatments with antidepressants and neuroleptics are predisposing factors for falls in older people in residential care. However, there seem to be differences between subgroups among these drugs and, from the perspective of fall prevention, SNRIs rather than SSRIs should perhaps be preferred in the treatment of depression in older people.

Place, publisher, year, edition, pages
2004. Vol. 16, no 4, 270-276 p.
Keyword [en]
Accidental Falls/*statistics & numerical data, Activities of Daily Living, Aged, Aged; 80 and over, Analgesics/adverse effects, Antidepressive Agents/adverse effects, Antipsychotic Agents/adverse effects, Cross-Sectional Studies, Health Services for the Aged, Humans, Prescriptions; Drug/*statistics & numerical data, Residential Facilities, Risk Factors, Serotonin Uptake Inhibitors/adverse effects, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-6743PubMedID: 15575120OAI: oai:DiVA.org:umu-6743DiVA: diva2:146413
Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Falls in older people in geriatric care settings: predisposing and precipitating factors
Open this publication in new window or tab >>Falls in older people in geriatric care settings: predisposing and precipitating factors
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Falls and their consequences are a major health problem in the older population, increasing their immobility, morbidity and mortality. This thesis focuses on older people living in geriatric care settings, frail older people who are most prone to suffer falls. The aim was to study predisposing and precipitating factors associated with falls in older people with or without cognitive impairment.

In a cross-sectional study with a one-year prospective follow-up for falls 63% of the 83 residents suffered 163 falls and 65% of the fallers fell more than once. The antidepressants selective serotonine reuptake inhibitors (SSRIs), impaired vision and being unable to use stairs independently were the factors most strongly associated with sustaining falls. Acute diseases were judged to have precipitated 32 % of the falls and drug side effects 9%.

In another cross-sectional study with a one-year follow-up for falls, including 199 residents, previous falls and treatment with antidepressants (mainly SSRIs) were found to be the most important predisposing factor for falls. Acute disease was judged to be the precipitating factor alone or in combination, in 39% of the falls, medical drugs in 8%, external factors such as obstacles in 8% and other conditions both related to the individual and the environment, such as misinterpretation, misuse of roller walkers or mistakes made by the staff were judged to have precipitated 17% of the falls.

In a population-based cross-sectional study including 3604 residents in geriatric care settings more than 8% sustained a fall at least once during the preceding week. A history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, use of neuroleptics and use of antidepressants were all associated with falls in multivariate analyses. In the subgroup of people with cognitive impairment (2008 residents) more than 9% had sustained a fall at least once during the preceding week. As for the whole population, being able to get up from a chair, previous falls, needing a helper when walking with the addition of hyperactive symptoms were the factors independently associated with falls.

In a study with a one-year prospective follow up for falls, including 439 residents in residential care facilities, 63% sustained 1354 falls, corresponding to an incidence rate of 3.5 falls / person year. Thirty-three percent of the falls and 37% of the injurious falls occurred during the night (9pm-6am). There were significantly higher fall rates in the evening and in January, April, May, November and December. There were no associations between fall rates and any of the weather parameters studied.

In conclusion falls and fall-related injuries in older people in geriatric care settings are common. Both predisposing and precipitating factors contribute to the risk of falling. Addressing precipitating factors for falls seems to be important in an individualised preventive strategy among older people in geriatric care settings.

Publisher
80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 902
Keyword
accidental falls, risk factors, older people, residential facilities, geriatric care, cognition, drug therapy, wounds and injuries, geriatric psychiatry, meteorological factors
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-307 (URN)91-7305-689-8 (ISBN)
Public defence
2004-09-24, Sal Betula, 6M, 09:00
Opponent
Available from: 2004-09-02 Created: 2004-09-02 Last updated: 2010-08-02Bibliographically approved

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Kallin, KristinaGustafson, YngveSandman, Per-OlofKarlsson, Stig
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