Association of polypharmacy with postural instability and impaired balance in community-dwelling older adults in Turkey

Yıl 2021, , 12 - 17, 29.01.2021

Gozde Sengul Aycıcek Gunes Arık Muhammet Cemal Kızılarslanoglu Fatih Sumer Omer Osman Pala Busra Can Ozgur Kara Selda Basar Zekeriya Ulger

https://doi.org/10.5472/marumj.869538

Cited By: 3

Öz

Objective: Polypharmacy, an important geriatric syndrome, has been shown to be an independent risk factor for falling. However, the
data about effects of polypharmacy on balance is lacking. We aimed to evaluate the effects of polypharmacy and inappropriate drug
use on balance in older adults.
Patients and Methods: Fifty-one patients using ≥ 5 drugs and 50 patients using < 5 drugs were included in the study. Inappropriate
drug usage of the patients was evaluated by Beers criteria. Postural stability and risk of falling was investigated by using Biosway
Portable Balance System (BPBS). Activities and functional status of the patients were assessed by using Short Physical Performance
Battery (SPPB) and Activities Specific Balance Confidence Scale (ABC). All patients underwent comprehensive geriatric assessment.
Results: Age, gender, hand grip strength, SPPB scores of the patients were similar between polypharmacy and control groups (all had
p>0.05). ABC score was higher in polypharmacy group than control (p<0.01). Overall, anterior-posterior, medial-lateral stability
index and eyes closed firm surface scores detected in BPBS were higher, indicating worse stability in the polypharmacy group than
control (p<0.05). Limit of stability score was lower in the polypharmacy group than control (p=0.03). Rates of polypharmacy and
inappropriate drug usage were higher in patients with a history of falling than without (p<0.01, p<0.01, respectively). In multivariate
analysis model, polypharmacy was found to be an independently correlated parameter for impaired balance (OR 24.31; 95%CI 3.05-
193.91; p<0.01).
Conclusion: This study has demonstrated that polypharmacy might be a related factor for impaired balance. Struggling with
polypharmacy should be one of the most important part of comprehensive geriatric assessment.

Anahtar Kelimeler

Balance, Elderly, Falling, Polypharmacy

Kaynakça

• Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med 2002; 18: 141-58. DOI: 10.1016/ s0749-0690(02)00002-2
• Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995; 43: 1214-21). doi: 10.1111/j.1532- 5415.1995.tb07396.x
• Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non – fatal falls among older adults. Inj Prev 2006; 12: 290-5. doi: 10.1136/ip.2005.011015.
• Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. J Forensic Sci 1996; 41: 733-46.
• Corsinovi L, Bo M, Ricauda Aimonino N, et al. Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric care unit. Arch Gerontol Geriatr 2009; 49: 142-145. doi: 10.1016/j.archger.2008.06.004
• Woolcott JC, Richardson KJ, Wiens MO, et al.Meta – analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009; 169: 1952-60. doi: 10.1001/ archinternmed.2009.357
• Laflamme L, Monárrez-Espino J, Johnell K, Elling B, Möller J.Type, number or both? A population base matched case – control study on the risk of fall injuries among older people and number of medications beyond fall inducing drugs. PLoS ONE 2015; 10: 1-12. doi:: 10.1371/journal.pone.0123390.
• Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991;151:1825-32.
• Beers MH. Explicit criteria for determining potentially inappropriate medication use by elderly. An update. Arch Intern Med 1997;157:1536.
• American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015; 63:2227-46. doi: 10.1111/ jgs.13702
• Ryan EE, Rossi MD, Lopez R. The effects of the contract-relax antagonist-contract form of proprioceptive neuromuscular facilitation stretching on postural stability. J Strength Cond Res 2010;24:1888-94. doi: 10.1519/JSC.0b013e3181ddad9d
• Shumway-Cook A, Woollacott M, Baldwin M. The effects of cognitive demands on postural sway in young versus older adults (fallers and nonfallers). Neurology Report 1995;19:44- 6.
• Khalaj N, Abu Osman NA, Mokhtar AH, Mehdikhani M, Wan Abas WA. Balance and risk of fall in individuals with bilateral mild and moderate knee osteoarthritis. PLoS ONE 2014; 9: 1-7. doi: 10.1371/journal.pone.0092270
• Vellas B, Guigoz Y, Garry PJ, et al. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116-22. doi: 10.1016/ s0899-9007(98)00171-3
• Katz S, Ford A. B, Moskowitz R. W, Jackson B. A, Jaffe M. W. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA.1963; 185: 914-9. doi: 10.1001/jama.1963.030.60120024016.
• Lawton MP, Broody EM. Assessment of older people: Selfmaintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179-86.
• Folstein MF, Folstein JE, McHugh PR. “Mini Mental State” a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-98. doi: 10.1016/0022-3956(75)90026-6
• Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale. A preliminary report. J Psychiatr Res 1983; 17: 37-49. doi: 10.1016/0022-3956(82)90033-4
• Biodex. Biodex balance system: clinical resource manual. Shirley, New York: Biodex Medical System Inc, 1999.
• Guralnik JM, Simonsick EM, Ferrucci L,et al., A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol1994: 49: M85-M94. doi: 10.1093/geronj/49.2.m85
• Powell LE, Myers AM The activities-specific balance confidence (ABC) scale. JGerontol A Biol Sci Medi Sci 1995;50:M28-M34. doi: 10.1093/gerona/50a.1.m28
• Díaz LB, Casuso-Holgado M J, Labajos-Manzanares M T, et al. Analysis of fall risk factors in an aging population living in long-term care institutions in SPAIN: A Retrospective cohort study. Int J Environ Res Public Health 2020;17:7234. doi: 10.3390/ijerph17197234
• Zaninotto P, Huang YT , Di Gessa Gt al. Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing. BMC Public Health 2020;20:1804. doi: 10.1186/s12889.020.09920-x
• Kojima T, Akishita M, Nakamura T, et al. Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 2012 ;12:425-30. doi: 10.1111/j.1447-0594.2011.00783.x
• Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II.Cardiac and analgesic drugs. J Am Geriatr Soc 1999;47 : 40-50. doi: 10.1111/j.1532-5415.1999.tb01899.x
• Nemmers TM, Miller JWJ. Factors influencing balance in healthy community-dwelling women age 60 and older. Geriatr Phys Ther 2008;31:93-100. doi: 10.1519/00139.143.200831030- 00003
• Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age Ageing 1997;26:189-93. doi: 10.1093/ageing/26.3.189
• Lajoie Y, Gallagher SP. Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr2004;38:11-26. doi: 10.1016/s0167- 4943(03)00082-7
• Eibling D. Balance disorders in older adults. Clin Geriatr Med 2018 ;34(2):175-81. doi: 10.1016/j.cger.2018.01.002
• Hsieh RL, Lee WC, Lo MT, Liao WC. Postural stability in patients with knee osteoarthritis: comparison with controls and evaluation of relationships between postural stability scores and International Classification of Functioning, Disability and Health components. Arch Phys Med Rehabil 2013 ;94340-6. doi: 10.1016/j.apmr.2012.09.022.
• Fransson PA, Gomez S, Patel M, Johansson L. Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces. Eur J Appl Physiol2007 ;101:81-9doi: 10.1007/s00421.007.0476-x
• Stillman BC. Making Sense of rPoprioception: The meaning of proprioception, kinaesthesia and related terms .Physiotherapy 2002;88 : 667-676. doi:10.1016/S0031-9406(05)60109-5
• Yaggie JA, McGregor SJ. Effects of isokinetic ankle fatigue on the maintenance of balance and postural limits. Arch Phys Med Rehabil 2002 ;83:224-8. doi: 10.1053/apmr.2002.28032