title: Different risk-increasing drugs in recurrent versus single fallers: are recurrent fallers a distinct population?
abstract: BACKGROUND
  Polypharmacy, and specifically the use of multiple fall-risk-increasing drugs (FRID), have been associated with increased risk of falling in older age. However, it is not yet clear whether the known set of FRIDs can be extrapolated to recurrent fallers, since they form a distinct group of more vulnerable older persons with different characteristics.
  
  
  OBJECTIVE
  We aim to investigate which classes of medications are associated with recurrent falls in elderly patients visiting the Emergency Department (ED) after a fall.
  
  
  METHODS
  This study had a cross-sectional design and was conducted in the ED of an academic medical center. Patients who sustained a fall, 65 years or older, and who visited the ED between 2004 and 2010 were invited to fill in a validated fall questionnaire designed to assess patient and fall characteristics (CAREFALL Triage Instrument [CTI]). We translated self-reported medications to anatomical therapeutic chemical (ATC) codes (at the second level). Univariate logistic regression analysis was performed to explore the association between medication classes and the outcome parameter (recurrent fall). Multivariate logistic regression was used to assess the associations after adjustment to potential confounders.
  
  
  RESULTS
  In total 2,258 patients participated in our study, of whom 39 % (873) had sustained two or more falls within the previous year. After adjustment for the potential confounders, drugs for acid-related disorders (adjusted odds ratio [aOR] 1.29; 95 % CI 1.03–1.60), analgesics (aOR 1.22; 95 % CI 1.06–1.41), anti-Parkinson drugs (aOR 1.59; 95 % CI 1.02–2.46), nasal preparations (aOR 1.49; 95 % CI 1.07–2.08), ophthalmologicals (aOR 1.51; 95 % CI 1.10–2.09); antipsychotics (aOR 2.21; 95 % CI 1.08–4.52), and antidepressants (aOR 1.64; 95 % CI 1.13–2.37) remained statistically significantly associated with an ED visit due to a recurrent fall.
  
  
  CONCLUSIONS
  Known FRIDs, such as psychotropic drugs, also increase the risk of recurrent falls. However, we found four relatively new classes that showed significant association with recurrent falls. In part, these classes may act as markers of frailty and comorbidity, or they may reflect differences in the risk factors affecting the older, frailer population that tends to sustain recurrent falls. Further investigation is needed to elucidate causes and ways to prevent recurrent falls.
authors: Marjan
authors: M
authors: Askari
authors: Saied
authors: S
authors: Eslami
authors: Alice C
authors: AC
authors: Scheffer
authors: Stephanie
authors: S
authors: Medlock
authors: Sophia E
authors: SE
authors: de Rooij
authors: Nathalie
authors: N
authors: van der Velde
authors: Ameen
authors: A
authors: Abu-Hanna
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D004364:Pharmaceutical Preparations; D019338:Polypharmacy; D012008:Recurrence; D012044:Regression Analysis; D012306:Risk
chemical_list: D004364:Pharmaceutical Preparations
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