Abstract
BackgroundFall injuries are stressful and painful and they have a range of serious consequences for older people. While there is some clinical evidence of unintentional poisoning by medication following a severe fall injuries, population-based studies on that association are lacking. This is investigated in the current study, in which attention is also paid to different clinical conditions of the injured patients.MethodsWe conducted a matched case-control study of Swedish residents 60 years and older from various Swedish population-based registers. Cases defined as adverse drug events (ADE) by unintentional poisoning leading to hospitalization or death were extracted from the National Patient Register (NPR) and the Cause of Death Register from January 2006 to December 2009 (n = 4418). To each case, four controls were matched by sex, age and residential area. Information on injurious falls leading to hospitalization six months prior to the date of hospital admission or death from ADE by unintentional poisoning, and corresponding date for the controls, was extracted from the NPR. Data on clinical conditions, such as dispensed medications, comorbidity and previous fall injuries were also extracted from the Swedish Prescribed Drug Register (SPDR) and NPR. Effect estimates were calculated using conditional logistic regression and presented as odds ratios (OR) and 95% confidence intervals (CI).ResultsWe found a three-fold increased risk of unintentional poisoning by medication in the six-month period after an injurious fall (OR 3.03; 95% CI, 2.54–3.74), with the most pronounced increase 1–3 weeks immediately after (OR, 7.66; 95% CI, 4.86–12.1). In that time window, from among those hospitalized for a fall (n = 92), those who sustained an unintentional poisoning (n = 60) tended to be in poorer health condition and receive more prescribed medications than those who did not, although this was not statistically significant. Age stratified analyses revealed a higher risk of poisoning among the younger (aged 60–79 years) than older elderly (80+ years).ConclusionMedication-related poisoning leading to hospitalization or death can be an ADE subsequent to an episode of hospitalization for a fall-related injury. Poisoning is more likely to occur closer to the injurious event and among the younger elderly. It cannot be ruled out that some of those falls are themselves ADE and early signs of greater vulnerability among certain patients.
Highlights
Fall injuries are stressful and painful and they have a range of serious consequences for older people
This study aims to determine the association between injurious falls and subsequent adverse drug events (ADE) by unintentional poisoning, and pays attention to different clinical conditions of the fall-injured patients
Individuals with a subsequent ADE after an injurious fall tend to have a higher comorbidity score (CCI >0: 44.3 vs. 35.0%), but tend to be less likely to be repeated fallers (26.6 vs. 33.3%). They seem to be more likely to have received opioids (21.7 vs. 9.4%) and analgesics (13.3 vs. 3.1%) The most commonly newly prescribed pharmaceutical drug groups were opioids (N02A), other analgesics and antipyretics (N02B), with paracetamol (n = 11) and oxycodone (n = 7) as the most commonly newly prescribed medications. In this large population-based study, we found that the risk of unintentional poisoning by medication is tripled in the six-month period following an episode of hospitalization for an injurious fall, with the excess risk peeking 1–3 weeks immediately after the fall
Summary
Fall injuries are stressful and painful and they have a range of serious consequences for older people. While medication has an important function in managing various types of health conditions, a range of studies reveal that it may increase the risk of falling among older people [8, 10, 12, 13]. This is the case for specific medications like opioids [14], certain combinations of medications and for polypharmacy [8, 12]. Even low numbers of medication used, below the polypharmacy threshold of five medications, increase the risk for falls and other injuries among older people [12, 15]
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