Drug Burden and its Association with Falls Among Older Adults in New Zealand: A National Population Cross-Sectional Study

Hamish A. Jamieson, Prasad S. Nishtala, Richard Scrase, Joanne M. Deely, Rebecca Abey-Nesbit, Martin J. Connolly, Sarah N. Hilmer, Darrell R. Abernethy, Philip J. Schluter

Research output: Contribution to journalArticle

Abstract

Background: Adverse outcomes associated with advanced diseases are often exacerbated by polypharmacy. Objectives: The current study investigated an association between exposure to anticholinergic and sedative medicines and falls in community-dwelling older people, after controlling for potential confounders. Methods: We conducted a retrospective cross-sectional study of a continuously recruited national cohort of community-dwelling New Zealanders aged 65 years and over. Participants had an International Resident Assessment Instrument–Home Care (interRAI-HC) assessment between 1 September 2012 and 31 January 2016. InterRAI-HC is a comprehensive, multi-domain, standardised assessment. This study captured 18 variables, including fall frequency, from the interRAI. These data were deterministically matched with the Drug Burden Index (DBI) for each participant, derived from an anonymised national dispensed pharmaceuticals database. DBI groupings were statistically ascertained, and ordinal regression models employed. Results: Overall, there were 71,856 participants, with a mean age of 82.7 years (range 65–106); 43,802 (61.0%) were female, and 63,578 (88.5%) were New Zealand European. In unadjusted and adjusted analyses, DBI groupings were related to falls (p < 0.001). A DBI score > 3 was associated with a 41% increase in falls compared with a DBI score of 0 (p < 0.001). There was a ‘dose-response’ relationship between DBI levels and falls risk. Conclusions: DBI was found to be independently and positively associated with a greater risk of falls in this cohort after adjustment for 18 known confounders. We suggest that the DBI could be a valuable tool for clinicians to use alongside electronic prescribing to help reduce falls in older people.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalDrugs and Aging
DOIs
StateAccepted/In press - Dec 8 2017
Externally publishedYes

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New Zealand
Cross-Sectional Studies
Pharmaceutical Preparations
Population
Independent Living
Drug Dose Response Relationship
Electronic Prescribing
Pharmaceutical Databases
Polypharmacy
Cholinergic Antagonists
Hypnotics and Sedatives

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Pharmacology (medical)

Cite this

Jamieson, H. A., Nishtala, P. S., Scrase, R., Deely, J. M., Abey-Nesbit, R., Connolly, M. J., ... Schluter, P. J. (Accepted/In press). Drug Burden and its Association with Falls Among Older Adults in New Zealand: A National Population Cross-Sectional Study. Drugs and Aging, 1-9. https://doi.org/10.1007/s40266-017-0511-5

Drug Burden and its Association with Falls Among Older Adults in New Zealand : A National Population Cross-Sectional Study. / Jamieson, Hamish A.; Nishtala, Prasad S.; Scrase, Richard; Deely, Joanne M.; Abey-Nesbit, Rebecca; Connolly, Martin J.; Hilmer, Sarah N.; Abernethy, Darrell R.; Schluter, Philip J.

In: Drugs and Aging, 08.12.2017, p. 1-9.

Research output: Contribution to journalArticle

Jamieson, HA, Nishtala, PS, Scrase, R, Deely, JM, Abey-Nesbit, R, Connolly, MJ, Hilmer, SN, Abernethy, DR & Schluter, PJ 2017, 'Drug Burden and its Association with Falls Among Older Adults in New Zealand: A National Population Cross-Sectional Study', Drugs and Aging, pp. 1-9. https://doi.org/10.1007/s40266-017-0511-5
Jamieson, Hamish A. ; Nishtala, Prasad S. ; Scrase, Richard ; Deely, Joanne M. ; Abey-Nesbit, Rebecca ; Connolly, Martin J. ; Hilmer, Sarah N. ; Abernethy, Darrell R. ; Schluter, Philip J. / Drug Burden and its Association with Falls Among Older Adults in New Zealand : A National Population Cross-Sectional Study. In: Drugs and Aging. 2017 ; pp. 1-9.
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AU - Nishtala, Prasad S.

AU - Scrase, Richard

AU - Deely, Joanne M.

AU - Abey-Nesbit, Rebecca

AU - Connolly, Martin J.

AU - Hilmer, Sarah N.

AU - Abernethy, Darrell R.

AU - Schluter, Philip J.

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AB - Background: Adverse outcomes associated with advanced diseases are often exacerbated by polypharmacy. Objectives: The current study investigated an association between exposure to anticholinergic and sedative medicines and falls in community-dwelling older people, after controlling for potential confounders. Methods: We conducted a retrospective cross-sectional study of a continuously recruited national cohort of community-dwelling New Zealanders aged 65 years and over. Participants had an International Resident Assessment Instrument–Home Care (interRAI-HC) assessment between 1 September 2012 and 31 January 2016. InterRAI-HC is a comprehensive, multi-domain, standardised assessment. This study captured 18 variables, including fall frequency, from the interRAI. These data were deterministically matched with the Drug Burden Index (DBI) for each participant, derived from an anonymised national dispensed pharmaceuticals database. DBI groupings were statistically ascertained, and ordinal regression models employed. Results: Overall, there were 71,856 participants, with a mean age of 82.7 years (range 65–106); 43,802 (61.0%) were female, and 63,578 (88.5%) were New Zealand European. In unadjusted and adjusted analyses, DBI groupings were related to falls (p < 0.001). A DBI score > 3 was associated with a 41% increase in falls compared with a DBI score of 0 (p < 0.001). There was a ‘dose-response’ relationship between DBI levels and falls risk. Conclusions: DBI was found to be independently and positively associated with a greater risk of falls in this cohort after adjustment for 18 known confounders. We suggest that the DBI could be a valuable tool for clinicians to use alongside electronic prescribing to help reduce falls in older people.

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