Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study

被引:64
作者
Thorell, Kristine [1 ,2 ]
Ranstad, Karin [2 ]
Midlov, Patrik [2 ]
Borgquist, Lars [3 ]
Halling, Anders [2 ,4 ]
机构
[1] Blekinge Cty Council, Dept Patient Safety, SE-37185 Karlskrona, Sweden
[2] Lund Univ, Dept Clin Sci Malmo, SE-20502 Malmo, Sweden
[3] Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden
[4] Univ Southern Denmark, Inst Publ Hlth, Res Unit Gen Practice, DK-5000 Odense C, Denmark
来源
BMC GERIATRICS | 2014年 / 14卷
关键词
Hip fracture; Multimorbidity level; Fall risk-increasing drugs; Elderly; Medication review; Sweden; SYSTEM-ACTIVE MEDICATIONS; AMBULATORY-CARE GROUPS; PRIMARY-HEALTH-CARE; OLDER-PEOPLE; PSYCHOTROPIC MEDICATIONS; CASE-MIX; METAANALYSIS; BENZODIAZEPINES; LIFE; AGE;
D O I
10.1186/1471-2318-14-131
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: Risk factors for hip fracture are well studied because of the negative impact on patients and the community, with mortality in the first year being almost 30% in the elderly. Age, gender and fall risk-increasing drugs, identified by the National Board of Health and Welfare in Sweden, are well known risk factors for hip fracture, but how multimorbidity level affects the risk of hip fracture during use of fall risk-increasing drugs is to our knowledge not as well studied. This study explored the relationship between use of fall risk-increasing drugs in combination with multimorbidity level and risk of hip fracture in an elderly population. Methods: Data were from Ostergotland County, Sweden, and comprised the total population in the county aged 75 years and older during 2006. The odds ratio (OR) for hip fracture during use of fall risk-increasing drugs was calculated by multivariate logistic regression, adjusted for age, gender and individual multimorbidity level. Multimorbidity level was estimated with the Johns Hopkins ACG Case-Mix System and grouped into six Resource Utilization Bands (RUBs 0-5). Results: 2.07% of the study population (N = 38,407) had a hip fracture during 2007. Patients using opioids (OR 1.56, 95% CI 1.34-1.82), dopaminergic agents (OR 1.78, 95% CI 1.24-2.55), anxiolytics (OR 1.31, 95% CI 1.11-1.54), antidepressants (OR 1.66, 95% CI 1.42-1.95) or hypnotics/sedatives (OR 1.31, 95% CI 1.13-1.52) had increased ORs for hip fracture after adjustment for age, gender and multimorbidity level. Vasodilators used in cardiac diseases, antihypertensive agents, diuretics, beta-blocking agents, calcium channel blockers and renin-angiotensin system inhibitors were not associated with an increased OR for hip fracture after adjustment for age, gender and multimorbidity level. Conclusions: Use of fall risk-increasing drugs such as opioids, dopaminergic agents, anxiolytics, antidepressants and hypnotics/sedatives increases the risk of hip fracture after adjustment for age, gender and multimorbidity level. Fall risk-increasing drugs, high age, female gender and multimorbidity level, can be used to identify high-risk patients who could benefit from a medication review to reduce the risk of hip fracture.
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页数:7
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