with an increased fall risk may be attributed to the fact that the need for fall prevention might have been anticipated in patients receiving opioids, because the risk of falling with opioids is well known. Effects of characteristics of medication use on fall risk Number of medications and drug–drug interaction In geriatric outpatients, polypharmacy rather than number of comorbidities was associated with fall risk, and the associa- tion of number of medications with fall risk was stepwise. Taking five or more drugs was significantly associated with an increased risk of falls in geriatric outpatients (OR 4.5, 95% CI 1.7–12.2) after adjusting for potential confounders. 33,34 Outpatients would experience a 14% increase in fall risk with the addition of each medication beyond a four-medication regimen (OR 1.14, 95% CI 1.02–1.27; P = 0.027). 35 Mizukami et al examined the prevalence of falls among community- dwelling elderly Japanese individuals, and found that taking at least four daily prescription medications ( P , 0.05) was significantly associated with falls. 36 Multivariate logistic regression analysis revealed that the overall OR of falling among patients using ten or more drugs was 8.42 (95% CI 4.73–15.0) compared with patients who used 0–1 drug per day. 37 Another study also showed particular risk for falling (OR 6.1) in patients taking 10 + drugs. 38 Patients who are taking many different types of medications are high-risk groups, where increased monitoring or tailored drug regimens is necessary. In a prospective cohort study of 204 patients (mean age 80.5 ± 8.3 years) admitted to hospital after a fall, frail participants (n = 103) had a significantly higher number of FRIDs on admission compared with robust patients (n = 101) (frail 3.4 ± 2.2 versus robust 1.6 ± 1.5, P , 0.0001), total number of medications (9.8 ± 4.3 versus 4.4 ± 3.3, P , 0.0001), and DDI exposure (35% versus 5%, P = 0.001). The number of FRIDs and to a lesser extent total medications at discharge
Therapeutics and Clinical Risk Management 2014:10 submit your manuscript | Dove press Dove press 442 Chen et al were significantly associated with recurrent falls (OR 1.7 and OR 1.2, respectively), but DDIs were not. 39 French et al analyzed 133,872 outpatient benzodiaz- epine prescriptions and . 1.5 million nonbenzodiazepine prescriptions. Micromedex ® software (Truven Health Analyt- ics, Rocky Hill, CT, USA) was used to identify combinations of benzodiazepines and other drugs that are likely to result in “major” interactions; 71.2% (790 of 1,110) of the unique patients who experienced an injury had used benzodiazepine in combination with another drug with a major severity rating defined by Micromedex. Interestingly, the occur- rence rate of fall incidents was only 4.3% (320 of 7,522) among patients who were taking benzodiazepines without concomitant use of precipitant drugs, whereas concomitant use of benzodiazepines and precipitant drugs increased the odds of an injury more than twofold.
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