Using pharmacy dispensing data to predict falls in older individuals
British Journal of Clinical Pharmacology, vol. 87, pp. 1282–1290
Abstract
AIMS: Associations between individual medication use and falling in older individuals are well-documented. However, a comprehensive risk score that takes into account overall medication use and that can be used in daily pharmacy practice is lacking. We, therefore, aimed to determine whether pharmacy dispensing records can be used to predict falls. METHODS: A retrospective cohort study was conducted using pharmacy dispensing data and self-reported falls among 3454 Dutch individuals aged ≥65 years. Two different methods were used to classify medication exposure for each person: the drug burden index (DBI) for cumulative anticholinergic and sedative medication exposure as well as exposure to fall risk-increasing drugs (FRIDs). Multinomial regression analyses, adjusted for age and sex, were conducted to investigate the association between medication exposure and falling classified as nonfalling, single falling and recurrent falling. The predictive performances of the DBI and FRIDs exposure were estimated by the polytomous discrimination index (PDI). RESULTS: There were 521 single fallers (15%) and 485 recurrent fallers (14%). We found significant associations between a DBI ≥1 and single falling (adjusted odds ratio: 1.30 [95% confidence interval {CI}: 1.02-1.66]) and recurrent falling (adjusted odds ratio: 1.60 [95%CI: 1.25-2.04]). The PDI of the DBI model was 0.41 (95%CI: 0.39-0.42) and the PDI of the FRIDs model was 0.45 (95%CI: 0.43-0.47), indicating poor discrimination between fallers and nonfallers. CONCLUSION: The study shows significant associations between medication use and falling. However, the medication-based models were insufficient and other factors should be included to develop a risk score for pharmacy practice.
Authors 6
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Affiliation as printed
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
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Ellen S. Koster corresponding
Affiliation as printed
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
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Affiliation as printed
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
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Martine Kruijtbosch Aachen
Utrecht University · SIR Institute for Pharmacy Practice and Policy
Affiliation as printed
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
SIR Institute for Pharmacy Practice and Policy Theda Mansholtstraat 5B Leiden JE 2331 The Netherlands
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
SIR Institute for Pharmacy Practice and Policy Theda Mansholtstraat 5B Leiden JE 2331 The Netherlands
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Affiliation as printed
Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy University of Groningen Groningen The Netherlands
Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy University of Groningen Groningen The Netherlands
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Affiliation as printed
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science Utrecht University Utrecht The Netherlands
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