Abstract
BackgroundThe simultaneous use of several medications is an important risk factor for injurious falls in older people. The aim of this study is to investigate the effect of the number of medications dispensed to elderly persons on fall injuries and to assess whether this relationship is explained by individual demographics, health habits and health status.MethodsA population-based, nested, case–control study on people 65 years and older (N = 20.906) was conducted using data from the Stockholm Public Health Cohort (SPHC) derived from self-administered surveys and linked at the individual level with various Swedish health registers. Fall injuries leading to hospitalization recorded in the Swedish National Patient Register (NPR) were considered as the outcome. The main exposure, obtained from the Swedish Prescribed Drug Register (SPDR), was the number of medications dispensed within 90 days prior to the injurious fall. The injury risk was estimated using adjusted odds ratios (ORs) from logistic regression. Results were adjusted by selected demographic, social circumstances, lifestyle and health status data extracted from the SPHC.ResultsAfter adjusting for common risk factors within demographics, lifestyle, social circumstances and health status, using more than one medication increased the risk of fall injury but no clear dose–response relationship was observed, with point estimates ranging from 1.5-1.7 for the use of two, three, four or five or more medications as compared to using none. An increased risk remained, and was even elevated, after adjusting for the use of fall-risk-increasing drugs (FRIDs).ConclusionsUsing more than one medication affects the risk of injurious falls among older people. The effect of any given number of medications studied remains and is even strengthened after adjusting for individual demographics, health habits, health conditions and the use of FRIDs.
Highlights
The simultaneous use of several medications is an important risk factor for injurious falls in older people
This study investigates the effect of the number of medications on fall injuries among older people and assesses to what extent this relationship is affected by individual demographics, health habits and health status
The Stockholm Public Health Cohort (SPHC) includes three cohorts recruited through the Public Health Surveys (PHS) conducted in 2002, 2006 and 2010 respectively, and datalinked at the individual level to the Swedish Total Population Register, the National Patient Register (NPR) and the Swedish Prescribed Drug Register (SPDR) using the Swedish personal identity number, a unique identification number assigned to all residents of Sweden
Summary
The simultaneous use of several medications is an important risk factor for injurious falls in older people. The aim of this study is to investigate the effect of the number of medications dispensed to elderly persons on fall injuries and to assess whether this relationship is explained by individual demographics, health habits and health status. The association between number of medications and injurious falls is complex and can be influenced by a range of other individual risk factors. Among those are individual demographic attributes such as gender and age, and health status [1,13,14,15]. Some studies suggest that the strength of the association is lower among the elderly and can be reversed [23], the evidence at hand remains scarce and largely descriptive
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