title: Factors associated with use of falls risk-increasing drugs among patients of a geriatric oncology outpatient clinic in Australia: a cross-sectional study.
abstract: Older people with cancer are at increased risk of falling. Falls risk-increasing drugs (FRIDs), comprising psychotropics and medications that cause orthostatic hypotension, are a potentially modifiable risk factor for falls. The objective of this study was to determine the prevalence and factors associated with use of FRIDs in older people with cancer. Patients aged ≥70 years who presented to a hospital outpatient clinic between January 2009 and July 2010 were included in the study. Information on current medication use, falls in previous 6 months, and frailty criteria was collected. Multinomial logistic regression was used to compute odds ratios (OR) and 95% confidence intervals (CIs) for factors associated with levels of FRID use. Overall, 76.1% (n = 293) of 383 patients used FRIDs. This comprised psychotropics (31.2%, n = 120) and medications causing orthostatic hypotension (69.9%, n = 269). In total, 24.0% (n = 92) patients reported falling in the previous 6 months. Risk factors for falling were associated with use of psychotropics but not orthostatic hypotension drugs. Patients with a history of falls had increased odds of using psychotropics (≥3 psychotropics; OR 13.50; 95%CI, 2.64-68.94). Likewise, frail patients had increased odds of using psychotropics (≥3 psychotropics; OR 27.78; 95%CI, 6.06-127.42). Risk factors for falling were associated with the use of psychotropics. This suggests that clinicians either do not recognize or underestimate the contribution of medications to falls in this high-risk patient group. Further efforts are needed to rationalize medication regimens at the time of patients' first presentation to outpatient oncology services.
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.|School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Justin P
authors.identifier: http://orcid.org/0000-0003-0613-108X
authors.initials: JP
authors.lastname: Turner
authors.affiliation: School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Tervonen
authors.affiliation: Department of Clinical Pharmacology, Faculty of Health Science, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Faculty of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Nimit
authors.initials: N
authors.lastname: Singhal
authors.affiliation: Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Prowse
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.|School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001315:Australia; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs
keywords: aged; clinical audit; clinical safety; evaluation; falls; falls risk-increasing drugs; frail elderly; geriatric oncology