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Journal Article

Citation

Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. BMJ Open 2017; 7(10): e016358.

Affiliation

Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.

Copyright

(Copyright © 2017, BMJ Publishing Group)

DOI

10.1136/bmjopen-2017-016358

PMID

29042378

Abstract

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.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


Language: en

Keywords

clinical pharmacology; epidemiology; geriatric medicine; primary care

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