Medication-Related Falls in Older People by Allen R. Huang and Louise Mallet


51FvjeUUAXL._SY291_BO1204203200_QL40_.jpg Author Allen R. Huang and Louise Mallet
Isbn 9783319323022
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Year 2016
Pages 261
Language English
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Category medicine



 

Medication-Related Falls in Older People Allen R. Huang • Louise Mallet Editors Medication-Related Falls in Older People Causative Factors and Management Strategies Editors Allen R. Huang Head, Division of Geriatric Medicine University of Ottawa and The Ottawa Hospital Associate Professor of Medicine University of Ottawa Adjunct Professor of Medicine McGill University Montréal, Québec Canada Louise Mallet Head, Faculty of Pharmacy Université de Montréal Montréal, Québec Canada Clinical Pharmacist in Geriatrics McGill University Health Centre Montréal, Québec Canada ISBN 978-3-319-32302-2 ISBN 978-3-319-32304-6 DOI 10.1007/978-3-319-32304-6 (eBook) Library of Congress Control Number: 2016944151 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Adis imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland Preface The aging of the world population is highlighting the problems encountered by older people as they seek health care. Medication use is a double-edged sword: the beneficial effects of drug therapy must be balanced against potential and real side effects that drugs can cause in older patients. The situation is made more complex for individual patients because of the multiple factors involved, such as the physiologic changes in the body due to aging processes, the accumulation of comorbidities, and the use of drugs to manage various conditions and symptoms. Falls are a dreaded event in older people. It can affect a person biologically, resulting in soft tissue and bony trauma including fractures, psychologically resulting in fear of falling and mental health well-being resulting in depression. The identification of and reduction in fall risks in older people is a worldwide concern. Falls (or the reduction in their numbers) are a ubiquitous quality measure of health care delivery. Medication use is an important and potentially modifiable factor. This book serves as a repository of knowledge and scientific evidence concerning medications and their effects on falls risk. The book will inform readers of the complexity of the issue of medication-related falls in older people and provide strategies for its management. The target audience for this book includes (1) health professionals with an interest in researching and caring for older people, (2) managers of institutions or health systems, (3) policy-makers and health system funding decision-makers, and (4) the general public seeking high-quality information on this topic – especially those individuals with aging parents who have experienced falls or medication problems. This book will not be able to provide a single solution to this important clinical problem because of its complexity. Perhaps in the future, as a convergence of genomics, proteomics, and therapeutics occurs, health science may be able to optimize medication use in each individual person to minimize the risk of side effects and adverse events. Ottawa, ON, Canada Montréal, QC, Canada Allen R. Huang Louise Mallet v Contents Part I: Background 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Allen R. Huang and Louise Mallet 2 The Aging Population and Falls: Consequences and Costs . . . . . . . . . . 7 Paula M. Horsley and Allen R. Huang 3 Falls Count and Counting Falls: Making Sense of Data About Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Nancy E. Mayo and Sabrina M. Figueiredo Part II: Drugs and Falls: Why Are Older People at Risk? 4 Polypharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Susan K. Bowles 5 Pharmacology of Drugs in Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Louise Mallet 6 Age-Related Physical and Physiologic Changes and Comorbidities in Older People: Association with Falls . . . . . . . . . . . . . 67 Gustavo Duque 7 Adverse Events and Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Shirley C.C. Huang and Alan J. Forster 8 Risk Factors for Falls in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 E. Kwan, S. Straus, and J. Holroyd-Leduc Part III: Medications Associated with Falls in the Elderly 9 Psychotropic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Andrea Iaboni and Benoit H. Mulsant 10 Benzodiazepines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Annemie Somers and Mirko Petrovic vii viii Contents 11 Drugs for Degenerative Neurologic Conditions: Antiparkinson Medications, Cholinesterase Inhibitors, and Memantine . . . . . . . . . . 135 Geneviève Lemay 12 Antihypertensives and Cardiovascular Medications . . . . . . . . . . . . . . 147 Rebecca L. Salbu, Rosanne M. Leipzig, and Fred C. Ko 13 Glucose Control Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Louise Mallet Part IV: Management of Medication-Related Falls 14 Inappropriate Medications and Risk of Falls in Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Jennifer Greene Naples, Joseph T. Hanlon, Christine M. Ruby, and Susan L. Greenspan 15 Identifying Explicit Criteria for the Prevention of Falls . . . . . . . . . . . 179 Denis Curtin, Stephen Byrne, and Denis O’Mahony 16 Approach to Medication Reviews in Older Adults . . . . . . . . . . . . . . . 191 Derek Dyks 17 Withdrawal of Fall Risk-Increasing Drugs . . . . . . . . . . . . . . . . . . . . . 199 Nathalie van der Velde and Tischa J.M. van der Cammen 18 Benzodiazepine Withdrawal in the Elderly: A Practical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Louise Mallet 19 Role of Information and Communication Technologies . . . . . . . . . . . 223 Allen R. Huang 20 A Novel Personalized Fall Risk Calculator: A Prototype for Improving the Safety of Prescribing Through Computerized Decision Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Robyn Tamblyn 21 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Allen R. Huang Part I Background Chapter 1 Introduction Allen R. Huang and Louise Mallet Abstract Every person will fall throughout their life. More than one-third of community-dwelling older adults fall every year. One of the important risk factors for falling is taking medications. The contents of this book will help the reader understand the various factors involved in increasing the risk for falls in older adults and the various medications that contribute to that risk. This book represents a repository of scientific evidence current at the time of its publication and can help students and researchers understand the problem. People involved in health policymaking may also be engaged to help address this global problem. Additionally anyone with an interest in this topic can learn about medications and falls. Books, in all their variety, offer the human intellect the means whereby civilisation may be carried triumphantly forward. (Winston Churchill, November 8, 1937, Statement for the National Book Fair) The inspiration for this book came from the editor-in-chief of the journal Drugs and Aging, Professor David Williamson. The invitational e-mail message arrived in my inbox one morning, asking whether I would be interested in editing a book on the topic of medication-related falls in the elderly. This topic was the subject of a review article published in Drugs and Aging in 2012 that was among the top 10 downloaded articles from that journal and was frequently cited in other works. After reflecting for a few hundreds of milliseconds, accounting for my aging neurones, I replied “yes” and immediately consulted with my colleague and geriatric pharmacist Louise Mallet. The idea of producing a book in the era of digital data, 9-second A.R. Huang, MDCM, FRCPC (*) Division of Geriatric Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada Adjunct Professor of Medicine, McGill University, Montréal, QC, Canada e-mail: [email protected] L. Mallet, BScPharm, PharmD, CGP, FESCP Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada Department of Pharmacy, McGill University Health Centre, Montréal, QC, Canada e-mail: [email protected] © Springer International Publishing Switzerland 2016 A.R. Huang, L. Mallet (eds.), Medication-related falls in older people, DOI 10.1007/978-3-319-32304-6_1 3 4 A.R. Huang and L. Mallet sound bites1, and instant information where “google” is now a verb2 initially seemed counter-intuitive. This book project reminds me of one of the original Star Trek television episodes, entitled “Court Martial” (season 1, episode 20, 1967) when Captain Kirk was accused of reckless behaviour during an ion storm, resulting in the ejection of a research pod in order to save the starship. His legal case was defended by attorney Samuel T. Cogley, who insisted on trusting his books and not relying on computer records. His case was won when the logician, Mr. Spock, observed that he was able to repeatedly win at computer chess, indicating that something had changed in the ship’s computer and therefore also the logs. The episode came to the conclusion that computers are not infallible and that human intuition, logic, and understanding of out of range results are needed to arrive at the truth. Similarly, I feel that books lend a permanency to information and knowledge. Maybe it represents a subconscious comfort, reliving the time spent in the medical library, searching for information by poring through references in the huge tomes of Index Medicus. Although a published work may appear static, the words and writing it contains embody the deep knowledge and personalities of the authors. Therefore, a book lives and breathes. The words tell the reader about the knowledge and wisdom the author wishes the reader to understand. Every person will fall throughout their life: as a toddler learning to walk, as a child and adolescent partaking in sporting activities, as an adult partaking in thrillseeking activities and finally as an older adult. More than one-third of communitydwelling older adults fall every year. One of the important risk factors for falling is taking medications. Prescription medications are a double-edged sword: they help manage various medical conditions and they also have potential side effects that can affect an older person’s blood pressure and neuromuscular control resulting in an increased risk for falling. The topic of medication-related falls in older people has many moving parts: physical and physiologic changes in the aging body, changes in the way the body handles medications and the effects of those medications, the puzzling presentation of illness in older people, the medication cascade, the need for health-care workers and professionals to think differently and health-care systems that need to better manage older patients. After all, we wish to improve the healthcare system to look after ourselves when we grow old and need those services for ourselves. We hope that this book will help health-care providers recognize the role of medications in increasing the risk of falls. With this awareness, more frequent review of medications and targeting of fall risk-increasing drugs and proactive interventions with the goal of fall prevention can occur. This book is divided into four parts. The Background section describes the scope of the global problem of falls and how to critically interpret the myriad published data on falls. Part 2, “Why Are Older People At Risk?” describes the various factors, both intrinsic to older people and extrinsic, that are modifiable which conspire to put older people at higher risk 1 Ryfe and Kemmelmeier [1]. The word “google” was added as a transitive verb to the Oxford English Dictionary on June 15, 2006. 2 1 Introduction 5 for falls. Part 3 drills down into the details of various medication classes that have been identified as being associated with increased fall risk. Finally in Part 4, “Management of Medication-Related Falls” evidence supporting various strategies will be presented that clinicians can use to modify fall risk in older patients taking medications. This work was designed to serve several purposes. Firstly, it represents a repository of scientific evidence concerning the topics discussed in each chapter. We had thought: “Wouldn’t it be handy to have a single volume containing all the significant references so that future students, and investigators would have this information at their fingertips?” Secondly, a reader who wishes to skim the chapters and scan the abstracts or very important points (VIPs) boxes can get a good overview of this important clinical topic. Thirdly, people who are involved in policy-making can use this book and the knowledge and data embedded in its chapters to develop systems (environmental, social, health, education) which can help address this global problem. Finally, people who are sometimes patients can read and learn about medications and falls. Although this book is destined to be available primarily in electronic format, we hope that it also finds a place on your bookshelf. For me a book is best embodied in its paper form. Paper is a universal operating system. It does not crash. Page corner turndowns become satisfying bookmarks. Touching a line of text with a highlighter pen or underlining with a pencil or pen somehow reinforces the understanding and memory of what was just read. Whatever your preference, Louise and I hope that this book will help you understand and appreciate the topic of medication-related falls in the elderly. Acknowledgments Lastly, Louise and I wish to gratefully acknowledge and thank all the contributors who invested their time to write in order to communicate their knowledge within this book. Reference 1. Ryfe DM, Kemmelmeier M (2011) Quoting practices, path dependency and the birth of modern journalism. J Stud 12:10–26 Chapter 2 The Aging Population and Falls: Consequences and Costs Paula M. Horsley and Allen R. Huang Abstract Adults 60 years of age and older are the fastest-growing group in the world. Falling is defined as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” and is a common clinical and public health problem that affects many older adults. Approximately 5-10% of falls result in serious injury to the person. Bipedal locomotion that evolved as humans evolved places us at higher risk for falling. Perturbations to circulatory, respiratory, nervous, and musculoskeletal systems, along with impaired cognition and concentration, can increase fall risk. Falls are costly. Falls can also have a significant impact on the quality of life of older adults. Fall prevention is paramount. Strategies aimed at preventing falls need to be multifaceted and widespread to address the many different risk factors. Adults over the age of 60 years are the fastest-growing group within the global population [28]. It is projected that this population group will increase in number from 841 million in 2013 to over 2 billion in 2050 [21]. This means that older adults, who currently make up 12% of the population, will more than double in size and make up 21.1 % of the population in the year 2050 [21]. By 2050 (or even a few years earlier), it is expected that older adults will outnumber children for the first time in the history of the world [21]. The growth of this population group is not expected to stop in 2050; in fact, the United Nations predicts that the number of older adults will continue to grow and will triple in number by the year 2100 [22, 23]. This tremendous increase in the global population of older adults will significantly impact society and our world as we know it. P.M. Horsley (*) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada e-mail: [email protected] A.R. Huang, MDCM, FRCPC Division of Geriatric Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada Adjunct Professor of Medicine, McGill University, Montréal, QC, Canada e-mail: [email protected] © Springer International Publishing Switzerland 2016 A.R. Huang, L. Mallet (eds.), Medication-related falls in older people, DOI 10.1007/978-3-319-32304-6_2 7 8 P.M. Horsley and A.R. Huang Although older adults make up a large proportion of our global population, it is important to note that some regions within the world have a greater impact on these numbers than others [30]. Based on statistics taken by the World Health Organization in 2013, the Region of the Americas, the Western Pacific Region, and the European Region currently have the highest proportion of adults over the age of 60 years (14 %, 15 %, and 21 %, respectively) [30]. Older adults in the African Region, Eastern Mediterranean Region, and Southeast Asia Region make up a smaller proportion of their populations, ranging from 5 to 8 % [30]. Therefore, the impact that this growing global population group has on each country varies geographically. Particular attention has been placed on the cohort of people aged 85 years and older, since this cohort is expanding at the most rapid rate and life expectancy for males and females combined in Canada is projected to increase from 82.6 years to 92.2 years by the year 2100 [23]. Falling is a common clinical and public health problem that affects many older adults around the world [15, 17, 20, 28, 29]. The World Health Organization defines a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” [27, 29]. Falls are a significant concern for many older adults, as approximately one-third of older adults living in the community fall each year [3, 6, 24]. As one ages, there is an increased risk of falling and the falls are often of greater significance [14]. This risk continues to increase over time [24], as evidenced by fatal fall rates peaking in the 85-year-old and older category [28]. Although not every fall leads to a serious injury, approximately 5–10 % do [3]. A fall can lead to chronic pain, fear of future falls, decreased independence, and decreased quality of life [28], as well as immobility, morbidity, early long-term care placement, and even death [15]. In 2012 alone, 28,753 deaths in the United States were due to unintentional falls [13]. Globally, unintentional falls are the second leading cause of injury resulting in death and most commonly occur in adults over the age of 60 years [27, 29]. In order to understand why humans fall, it is important to consider many factors that increase one’s risk of falling, starting with our desire to walk on two feet. The evolution of the human ability to walk upright occurred in a stepwise manner, as evidenced by differing physical features seen in our ancestors as we transitioned from quadrupeds to bipeds [26]. As a biped, the human body relies heavily on the musculoskeletal system and brain to continuously make adjustments to one’s posture due to the lack of rigid fixation between our vertically stacked body parts [16]. This lack of fixation, combined with a constant force of gravity acting upon it, increases our risk of falling whenever we move and disturb this vertical alignment [16]. A high center of mass, as a result of our upright posture, and small surface area with which to balance on further contribute to our instability as bipeds [16]. The pathophysiology of a fall in older adults is complex and often involves a combination of many different factors [1, 12]. Adding to this complexity is the significant amount of diversity between older adults, which makes it even more difficult to determine an individual person’s risk for falling [28]. The intricate interplay of many different systems, such as the coordinated interactions of the circulatory, respiratory, nervous, and musculoskeletal systems, along with functioning cognition 2 The Aging Population and Falls: Consequences and Costs 9 and concentration, plays an important role in fall prevention [1, 15, 20]. With age, these systems start to become less efficient and effective, which increases one’s risk for falling [1]. Older adults often have a more rigid and less coordinated gait than younger populations, which, in combination with decreased reflexes, muscle strength, and posture control, impairs their ability to maintain balance [15]. There are also many external factors that can increase an individual’s risk for falling, such as environmental hazards [28, 29], individual behaviors (such as risk-taking and ethanol consumption) [28], pain [19], and a selection of associated medications [1, 4, 7, 9, 20, 24]. The subsequent chapter on “Age-Related Physical and Physiologic Changes and Co-morbidities in Older People: Association With Falls” will describe these factors in detail. Falls are costly. Approximately 0.85–1.5 % of total health-care dollars in North America, Australia, the United Kingdom, and Europe are spent on costs relating to falls [8, 14]. Based on the data collected by Stevens and colleagues [18] and correcting for inflation, the Centers for Disease Control and Prevention estimated that the direct medical costs for falls in the elderly in 2013 in the United States were approximately US$ 34 billion [2]. The actual cost is likely higher, as estimates do not take into account the costs associated with disability, reliance on others, time lost from both in-home and out-of-home work, or decreased quality of life [2]. Current projections indicate a continued increase in the costs associated with falls, as the global population ages and more falls occur [2]. Not only are falls costly, but they can also have a significant impact on the life of older adults. The fear of falling is a common concern that affects many individuals, even in those who have no previous history of falling [11]. Sixty-three percent of seniors in long-term care and 26–55 % of community dwelling older adults are afraid of falling [10]. Older adults will often limit their activities, resulting in physical deconditioning and a decreased quality of life, due to fear of injuring themselves when mobilizing [10, 15]. In addition to concerns about injury, older adults often fear falling because they do not want to be embarrassed socially, lose their independence, or need to move out of their own home [28]. Fall prevention is paramount. Strategies aimed at preventing falls need to be multifaceted and widespread to address many different risk factors that play a role in falling [29]. As described by the World Health Organization in their recent agefriendly world initiative, proper community planning, such as ensuring that buildings are accessible, public transportation is safe, and social and leisure activities are abundant and available for older adults, is an essential component in fall prevention [31]. Assessing and modifying one’s own home environment, particularly in highrisk fallers, to increase safety and minimize hazards have also been found to reduce the risk of falling in older adults [6]. Promoting healthy societal and individual attitudes, such as encouraging older adults to stay active, participate in social activities, and ask for help when needed, would help dispel the false belief that falling is a normal age-related change and would also help engage individuals in fall prevention precautions [25, 28, 31]. Physical activity has been shown to help prevent falls in the elderly [5, 6], including falls that would have resulted in severe injury [5]. Muscle strengthening, flexibility, and improving sense of balance have been shown to be 10 P.M. Horsley and A.R. Huang cost-effective ways to address this multifaceted issue. Last but certainly not least, proper management of medications plays a key role in preventing falls [4, 7, 9, 24]. Polypharmacy is a common clinical challenge that must be reviewed and evaluated at each clinical encounter, as many medications, especially when taken improperly, increase one’s risk for falling [4, 7, 9, 24]. Spending time to review medications can help ensure that patients are taking the correct medications, at the correct doses, and all unnecessary medications are deprescribed appropriately, in order to maximize benefit and minimize potential harm [4, 9]. Limiting the number and frequency of medications, educating patients about their medications, and organizing the medications for patients, such as in blister packs or dosette boxes, can help improve adherence and possibly decrease the risk for medication-related falls [7]. Details will follow in subsequent chapters in this book. In summary, the global population is aging; projections suggest that the number of older adults will increase twofold by 2050 and threefold by 2100. Falls are a common health concern among older adults and have a significant impact on both the individual and the health-care system. A proactive approach to fall prevention needs to be implemented, as reactionary approaches have been shown to be more costly. Designing interventions that work at the individual, environmental, social, and governmental levels will ensure many different risk factors are targeted and outcomes are optimized. We invite the readers to explore the contents of this book in order to understand the opportunities that exist for improving this significant health-care problem. References 1. Al-Aama T (2011) Falls in the elderly. Can Fam Physician 57:771–776 2. Centers for Disease Control and Prevention (2015) Cost of falls among older adults. Accessed on 18 Jan 2016. From http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html 3. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E (2010) Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21(5):658–668 4. Dyks D, Sadowski CA (2015) Interventions to reduce medication-related falls. Can Geriatr Soc J Contin Med Educ 5(1):23–31 5. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P (2013) The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. Br Med J 347, F6234. doi: 10.1136/ bmj.f6234 (Published 29 October 2013) 6. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE (2012) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev (9):CD007146. DOI: 10.1002/14651858.CD007146.pub3. 7. Hart M, Giancroce P (2015) Safer prescribing in elderly patients. Can Geriatr Soc J Contin Med Educ 5(1):16–22 8. Heinrich S, Rapp K, Rissmann U, Becker C, Konig HH (2010) Cost of falls in old age:a systemati review. Osteoporosis International 21(6):891–902 9. Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R (2012) Medicationrelated falls in the elderly. Drugs Aging 29(5):360–376 2 The Aging Population and Falls: Consequences and Costs 11 10. Lach HW, Parsons JL (2013) Impact of fear of falling in long term care: an integrative review. J Am Med Dir Assoc 14(8):573–577 11. Liu JYW (2015) Fear of falling in robust community-dwelling older people: results of a crosssectional study. J Clin Nurs 24:393–405. doi:10.1111/jocn.12613 12. López-Soto PJ, Manfredini R, Smolensky MH, Rodríguez-Borrego MA (2015) 24-hour pattern of falls in hospitalized and long-term care institutionalized elderly persons: a systematic review of the published literature. Chronobiol Int 32(4):548–556 13. Murphy SL, Kochanek KD, Xu J, Heron M (2015) Deaths: final data for 2012. Accessed on 18 Jan 2016. From http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_09.pdf 14. Peel NM (2011) Epidemiology of falls in older age. Can J Aging/La Rev Can Vieillissement 30(01):7–19 15. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35:ii37–ii41 16. Skoyles JR (2006) Human balance, the evolution of bipedalism and disequilibrium syndrome. Med Hypotheses 66:1060–1068 17. Speechley M (2011) Unintentional falls in older adults: a methodological historical review. Can J Aging/La Rev Can Vieillissement 30(01):21–32. doi:10.1017/S0714980810000735. 18. Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Injury Prevention 12:290–295. 19. Stubbs B, Binnekade T, Eggermont L, Sepehry AA, Patchay S, Schofield P (2014) Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Arch Phys Med Rehabil 95(1):175–187.e9 20. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707 21. United Nations (2013) World population ageing 2013. Accessed on 14 April 2016. From http:// w w w. u n . o r g / e n / d e v e l o p m e n t / d e s a / p o p u l a t i o n / p u b l i c a t i o n s / p d f / a g e i n g / WorldPopulationAgeing2013.pdf 22. United Nations (2015) Word population projected to reach 9.7 billion by 2050. Accessed on 18 Jan 2016. From http://www.un.org/en/development/desa/news/population/2015-report.html 23. United Nations (2015) World population prospects: key findings and advance tables. Accessed on 14 April 2016. From http://esa.un.org/unpd/wpp/Publications/Files/Key_ Findings_WPP_2015.pdf 24. Van Der Cammen TJM, Rajkumar C, Onder G, Sterke C, Petrovic M (2014) Drug cessation in complex older adults: time for action. Age Aging 43:20–25 25. Van Der Meulen E, Zijlstra GAR, Ambergen T, Kempen GIJM (2014) Effect of fall-related concerns on physical, mental, and social function in community-dwelling older adults: a prospective cohort study. J Am Geriatr Soc 62(12):2333–2338 26. Williams SA, Russo GA (2015) Evolution of the hominoid vertebral column: the long and the short of it. Evol Anthropol Issues News Rev 24(1):15–32 27. World Health Organization (n.d.) Falls. Accessed on 14 April 2016. From http://www.who.int/ violence_injury_prevention/other_injury/falls/en/ 28. World Health Organization (2007) WHO global report on falls prevention in older age. Accessed on 18 Jan 2016. From http://www.who.int/ageing/publications/Falls_prevention7March.pdf?ua=1 29. World Health Organization (2012) Falls. Accessed on 14 April 2016. From http://www.who. int/mediacentre/factsheets/fs344/en/# 30. World Health Organization (2015) World health statistics 2015. Accessed on 14 April 2016. From http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_eng.pdf?u=1&ua=1 31. World Health Organization (2015) Age-friendly world. Accessed on 14 April 2016. From http://agefriendlyworld.org/en/ Chapter 3 Falls Count and Counting Falls: Making Sense of Data About Falls Nancy E. Mayo and Sabrina M. Figueiredo Abstract It is often challenging to make sense of research reports on falls. The choice of statistical method depends on whether the outcome is binary (faller: yes/no), a rate (falls per person-time in view), ordinal (number of falls per person) or time to fall (first). The most useful methods for analysing falls are those that estimate parameters as they provide an estimated value for risk associated with different levels of a factor or intervention. Less useful are statistics that simply provide a yes/no answer as to whether the factor or intervention affects risk (hypothesis testing). As falls are negative events, when parameters such as odds ratios (OR), incidence rate ratios (IRR), hazard ratios (HR), proportional odds ratios (POR) or cumulative odds ratios (COR) are greater than 1.0, they indicate that the factor is associated with a higher risk of falls; when <1.0, the factor or the intervention is associated with a lower risk of falls. All of these statistical parameters can be used to identify risk factors for falls or to evaluate effective interventions. N.E. Mayo, BSc(PT), MSc, PhD (*) Center for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, QC, Canada Faculty of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada e-mail: [email protected] S.M. Figueiredo, BSc(PT), MSc Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada e-mail: [email protected] © Springer International Publishing Switzerland 2016 A.R. Huang, L. Mallet (eds.), Medication-related falls in older people, DOI 10.1007/978-3-319-32304-6_3 13 14 N.E. Mayo and S.M. Figueiredo Abbreviations AR CI COR df FRIDs GEE HR IRR IR NNH NNT OBD OR PAR POR RCT RR SD VIP 3.1 Attributable risk Confidence interval Cumulative odds ratios Degree of freedom Fall risk-increasing drugs Generalised estimating equations Hazard ratio Incidence rate ratio Incidence rate Number needed to harm Number needed to treat Occupied bed days Odds ratio Population attributable risk Proportional odds ratios Randomised controlled trial Rate ratio Standard deviation Very important point Falls Are an Important Health Concern Falls are the leading cause of injury amongst seniors across Canada [1] resulting in disability, chronic pain, loss of independence, reduced quality of life and even death [2–5]. In 2012–2013, Canadian seniors experienced almost 85,000 fall-related hospitalizations; of those, 39 % involved a hip fracture and 8 % resulted in an in-hospital death [6]. In addition to physical disabilities, falls also lead to psychosocial consequences. Falls may result in fear of falling, which opens a vicious cycle of reduced confidence, reduced mobility and social participation, weakness and deconditioning, which then culminate with recurrent falls [7, 8]. Going beyond patients’ perspective, falls also represent a financial burden to the health-care system [6]. According to the Public Health Agency of Canada [1], more than $2 billion is spent each year with fall-related expenses in the senior population. For instance, on average, patients admitted with a fall-related hospitalisation stayed 6 days longer than all other hospitalizations and 29 % of nonresidential care patients were transferred to residential care after a fall-related hospitalisation [9]. These physical, mental and economic implications are even more alarming due to the fact that the number of falls is expected to increase as seniors are the fastestgrowing segment of the population [9, 10].

Author Allen R. Huang and Louise Mallet Isbn 9783319323022 File size 4MB Year 2016 Pages 261 Language English File format PDF Category Medicine Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare Comprising a single repository of knowledge and scientific evidence in the field, this book provides strategies to mitigate fall risk by providing information on the complex interactions between aging processes, co-morbid conditions and prescribed medications in older patients. Geriatric health is becoming a more prominent issue as the population ages, and balancing the beneficial effects of medication against the potential and real side-effects in these patients involves a deliberate and thoughtful task: physiologic aging, the accumulation of co-morbidities, and the use of drugs to manage various conditions and symptoms generates a unique set of problems for each patient. Falls are a dreaded event in older people. The event can affect a person in a physical, and psychological manner, resulting in soft tissue and bony injury, fear of falling, and depression. The identification of and reduction in fall risks in older people is a worldwide concern, and reducing the incidence of falls is a ubiquitous quality measure of health care delivery. Heterogeneity amongst older people precludes a single solution. However, physicians and others involved in the care of geriatric patients will benefit from the presented insights into how medication use can be modified to limit its impact as a contributing factor.     Download (4MB) The Impossibility of Perfection: Aristotle, Feminism, and the Complexities of Ethics Behavioral Integrative Care: Treatments That Work in the Primary Care Setting Palliative Care, 2nd Edition Motor Neuron Disease in Adults Around the Patient Bed: Human Factors and Safety in Health Care Load more posts

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