Female Gender and Polypharmacy Results in An Increased Risk of High-Energy Trauma Associated With Falls in Elderly People

Yıl 2020, Cilt: 6 Sayı: 3, 162 - 168, 19.09.2020

Bülent Yardımcı İsmail Özkaya Yusuf Bayrak

https://doi.org/10.5455/umj.20200610062305

Öz

Introduction: Falls represent a major clinical problem in the elderly population. Accordingly, the prevention of falls is clinically important in this vulnerable population. The aim of the present study was to evaluate the clinical characteristics associated with falls and to define a patient subgroup that is at increased risk.
Materials and Methods: Consecutive patients aged ≥65 years, who presented with falls at the Emergency Department of American Hospital, Istanbul, Turkey, from 01/02/2014 to 01/02/2015, were included in this cross-sectional study.
Results: A total of 166 (17%) patients met the study inclusion criteria, comprising 110 (57.2%) females and 56 (33.7%) males. The mean age was 86.2±7.6 (66-105) years. The incidence of high-energy trauma was significantly higher in individuals aged >80 years (t=6.71; p=0.0054). Female gender was associated with an increased risk of high-energy trauma (x²=9.51; p=0.003). The frequency of angiotensin-converting enzyme inhibitors and polypharmacy was significantly higher in the high energy trauma group (p<0.001).
Conclusion: Women aged >80 years are at an increased risk of falls. Moreover, polypharmacy is associated with falls that lead to high-energy trauma. Healthcare providers should pay particular attention to this patient group to prevent high-energy falls that may lead to temporary or permanent injuries.

Anahtar Kelimeler

Elderly , women , falls , injury , trauma

Kaynakça

• Active Ageing: A Policy Framework: Geneva: World Health Organization, 2002. Available at www.who.int/ageing/publications/active/en/index.html, Accessed: January 30,2017.
• Norman Vetter. The epidemiology of ageing. In: Fillit MH, Rockwood K, Woodhouse K (Eds). Brocklehurst’s Textbook of Geriatric Medicine and Gerontology. Souders & Elsevier, Philadelphia, USA 2010:3-10
• Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701-1707
• Nevitt MC, Cummings SR, Hues ES. Risk Factors for injurious falls: a prospective study. J Gerontol. 1991;46:164-170
• Stevens JA, Corso PS, Finkelstein EA, et al. The costs of fatal and non-fatal falls among older adults. Inj Prev 2006;12:290-295
• Hornbrook MC, Stevens VJ, Wingfield DJ, et al. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist. 1994;34:16-23
• Luukinen H, Koski K, Honkanen R, et al. Incidence of injury causing falls among older adults by place of residence: a population-based study. J Am Geriatr Soc 1995;43:871-876
• Kiely DK, Kiel DP, Burrows AB, et al. Identifying nursing home residents at risk for falling. J Am Geriatr Soc. 1998;46:551-555
• Kron M, Loy S, Sturm E, et al. Risk indicator for falls in institutionalized frail elderly. Am J Epidemiol. 2003;158:645-653
• Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: Psychotropic drugs. J Am Geriatr Soc. 1999;47:30-39
• Rosanne M, Leipzig RM, Cumming RG, et al. 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
• Katz M, Okuma MAA, dos Santos ALG, et al. Epidemiology of high-energy trauma injuries among the elderly. Acta Ortop Bras. 2008;16:279-283
• American Geriatrics Society, British Geriatrics Society. Clinical practice guidelines: prevention of falls in older persons. New York, NY: American Geriatrics Society; 2010. Available at http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/. Accessed: January 30, 2017
• Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;15:CD007146
• Stevens JA, Ballesteros MF, Mack KA, et al. Gender Differences in Seeking Care for Falls in the Aged Medicare Population. Am J Prev Med. 2012;43:59-62
• Delbaere K, Van den Noortgate N, Bourgois J, et al. The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study. Clin Rehabil. 2006;20:83-90
• Aoyama M, Suzuki Y, Onishi J, et al. Physical and functional factors in activities of daily living that predict falls in community-dwelling older women. Geriatr Gerontol Int. 2011; 11:348–357
• Deandrea S, Bravi F, Turati F, et al. Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr. 2013;56:407-415
• Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. Journal of clinical epidemiology. 1990;43:1415-1420
• Robbins AS, Rubenstein LZ, Josephson KR et al. Predictors of falls among elderly people. Results of two population-based studies. Archives of internal medicine. 1989;149:1628-1633
• Tinetti ME, Kumar C. The patient who falls: “It’s always a trade-off.” JAMA 2010;303:258-266
• Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón JJ, et al. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol. 2000;16: 849-859
• Wickham C, Cooper C, Margetts BM, et al. Muscle strength, activity, housing and the risk of falls in elderly people. Age Ageing. 1989;18:47-51
• Hu G, Baker SP. Recent increases in fatal and non-fatal injury among people aged 65 years and over in the USA. Inj Prev. 2010;16:26-30
• World Health Organization Europe. What are the main risk factors for falls among older people and what are the most effective interventions to prevent these falls? WHO Regional Office for Europe (Health Evidence Network report; 2004). Available at http://www.euro.who.int/document/E82552.pdf Accessed: January 30, 2017
• Turkish Statistical Instıtute; Life Tables. Avaliable at http:// www.turkstat.gov.tr/PreHaberBultenleri.do?id=18522 Accessed: January 30, 2017
• 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;169:1952-1960
• French DD, Campbell R, Spehar A, et al. National outpatient medication profiling: medications associated with outpatient fractures in community-dwelling elderly veterans. Br J Clin Pharmacol. 2007;63:238-244
• Carey BJ, Potter JF. Cardiovascular causes of falls. Age Ageing 2001;30(Suppl 4):19-24
• 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;169:1952-1960