Relationship between potentially inappropriate medications and functional prognosis in elderly patients with distal radius fracture: a retrospective cohort study

Takako Nagai,Koji Tanimoto,Hiroshi Uei,Kazuyoshi Nakanishi,Masahiro Nagaoka,Yoshiaki Tomizuka

doi:10.1186/s13018-020-01861-w

Takako Nagai, Koji Tanimoto + Show 4 more

Open Access

https://doi.org/10.1186/s13018-020-01861-w

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Abstract

BackgroundPotentially inappropriate medications (PIMs) are a major concern in geriatric care. PIMs increase the risk of falls in elderly patients. However, the relationship between PIMs, subsequent falls, and functional prognosis for distal radius fracture (DRF) remains unclear. The aim of this study was to examine the relationship between PIMs, activities of daily living, and subsequent falls in elderly DRF patients.MethodsThe study included 253 patients aged ≥ 65 years who required surgical treatment for DRF. Clinical characteristics of patients obtained included age, sex, body mass index, number of medicines used at admission, number and type of PIMs used at admission, bone mineral density, use of drugs for osteoporosis, severity of comorbidities, nutritional status, Barthel Index (BI), length of hospital stay, subsequent falls, fracture type, and Mayo wrist score. Subjects were divided into two groups according to PIMs use and no use. Propensity score matching was used to assess patient characteristics and confirm factors affecting BI and subsequent falls.ResultsOne hundred seven patients (42.3%) were prescribed PIMs upon hospital admission. The mean BI gain was significantly lower in patients prescribed PIMs than in those who were not (p = 0.006), as was the rate of falls post-surgery (p = 0.009). Multivariate analysis of BI gain showed that PIMs affected BI gain (95% confidence interval [CI], − 1.589 to − 0.196, p = 0.012), and logistic regression analysis revealed that PIMs influenced subsequent falls (odds ratio, 0.108, 95% CI, 1.246 to 2.357, p < 0.001).ConclusionsPIM use hindered the improvement in activities of daily living and increased the incidence of subsequent falls in patients assessed. These results demonstrate the importance of appropriate drug control for patients with DRF.

Highlights

Inappropriate medications (PIMs) are a major concern in geriatric care
Measurements Data including patient age, sex, body mass index, total number of medicines used at admission, number and type of Potentially inappropriate medications (PIMs) used at admission, bone mineral density, use of drugs for osteoporosis, fracture type, serum albumin level, comorbidity severity (Charlson Comorbidity Index [CCI]), Barthel Index (BI), BI gain, Mayo score, length of hospital stay, and occurrence of subsequent falls were reviewed for each patient
Univariate analysis after Propensity score (PS) matching revealed that the two groups significantly differed with regard to CCI, number of drugs used upon admission, BI gain, and subsequent fall rate

Summary

Introduction

PIMs increase the risk of falls in elderly patients. The relationship between PIMs, subsequent falls, and functional prognosis for distal radius fracture (DRF) remains unclear. The aim of this study was to examine the relationship between PIMs, activities of daily living, and subsequent falls in elderly DRF patients. Maki et al investigated the effect of polypharmacy on the occurrence of hip fractures in patients who took five or more oral medications and reported that patients experienced longer hospital stays and had decreased Barthel Index (BI) efficiency, relative to those taking fewer drugs [12]. PIMs increase the risk of falls, emergency department visits, and unplanned hospitalizations in elderly patients. Masumoto et al [13] reported that 32.3% of elderly people with chronic diseases use PIMs, and PIMs and polypharmacy increase the risk of falls

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