多药
医学
比率
人口学
入射(几何)
队列
队列研究
人口
老年学
毒物控制
老年病科
纵向研究
流行病学
伤害预防
前瞻性队列研究
置信区间
内科学
急诊医学
精神科
环境卫生
社会学
病理
物理
光学
作者
Nafeesa Dhalwani,Radia Fahami,Harini Sathanapally,Samuel Seidu,Melanie J. Davies,Kamlesh Khunti
出处
期刊:BMJ Open
[BMJ]
日期:2017-10-01
卷期号:7 (10): e016358-e016358
被引量:197
标识
DOI:10.1136/bmjopen-2017-016358
摘要
Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.Longitudinal cohort study.The English Longitudinal Study of Ageing waves 6 and 7.5213 adults aged 60 or older.Rates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.A total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9-2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67).We found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.
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