Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies
Abstract Background Medications influencing the risk of fall-related injuries (FRIs) in older adults have been inconsistent in previous guidelines. This study employed case–control design to assess the association between FRIs and medications, and an additional case-crossover design was conducted to...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-023-04138-z |
| _version_ | 1797773970193252352 |
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| author | Yu-Seon Jung David Suh Eunyoung Kim Hee-Deok Park Dong-Churl Suh Sun-Young Jung |
| author_facet | Yu-Seon Jung David Suh Eunyoung Kim Hee-Deok Park Dong-Churl Suh Sun-Young Jung |
| author_sort | Yu-Seon Jung |
| collection | DOAJ |
| description | Abstract Background Medications influencing the risk of fall-related injuries (FRIs) in older adults have been inconsistent in previous guidelines. This study employed case–control design to assess the association between FRIs and medications, and an additional case-crossover design was conducted to examine the consistency of the associations and the transient effects of the medications on FRIs. Methods This study was conducted using a national claims database (2002–2015) in Korea. Older adults (≥ 65 years) who had their first FRI between 2007 and 2015 were matched with non-cases in 1:2 ratio. Drug exposure was examined for 60 days prior to the date of the first FRI (index date) in the case–control design. The hazard period (1–60 days) and two control periods (121–180 and 181–240 days prior to the index date) were investigated in the case-crossover design. The risk of FRIs with 32 medications was examined using conditional logistic regression after adjusting for other medications that were significant in the univariate analysis. In the case-crossover study, the same conditional model was applied. Results In the case–control design, the five medications associated with the highest risk of FRIs were muscle relaxants (adjusted odd ratio(AOR) = 1.35, 95% confidence interval (CI) = 1.31–1.39), anti-Parkinson agents (AOR = 1.30, 95%CI = 1.19–1.40), opioids (AOR = 1.23, 95%CI = 1.19–1.27), antiepileptics (AOR = 1.19, 95%CI = 1.12–1.26), and antipsychotics (AOR = 1.16, 95%CI = 1.06–1.27). In the case-crossover design, the five medications associated with the highest risk of FRIs were angiotensin II antagonists (AOR = 1.87, 95%CI = 1.77–1.97), antipsychotics (AOR = 1.63, 95%CI = 1.42–1.83), anti-Parkinson agents (AOR = 1.58, 95%CI = 1.32–1.85), muscle relaxants (AOR = 1.42, 95%CI = 1.35–1.48), and opioids (AOR = 1.35, 95%CI = 1.30–1.39). Conclusions Anti-Parkinson agents, opioids, antiepileptics, antipsychotics, antidepressants, hypnotics and sedatives, anxiolytics, muscle relaxants, and NSAIDs/antirheumatic agents increased the risk of FRIs in both designs among older adults. Medications with a significant risk only in the case-crossover analysis, such as antithrombotic agents, calcium channel blockers, angiotensin II antagonists, lipid modifying agents, and benign prostatic hypertrophy agents, may have transient effects on FRIs at the time of initiation. Corticosteroids, which were only associated with risk of FRIs in the case–control analysis, had more of cumulative than transient effects on FRIs. |
| first_indexed | 2024-03-12T22:13:51Z |
| format | Article |
| id | doaj.art-a935b054a2bc4cd48e44ad58c36d621d |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-12T22:13:51Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-a935b054a2bc4cd48e44ad58c36d621d2023-07-23T11:26:16ZengBMCBMC Geriatrics1471-23182023-07-0123111310.1186/s12877-023-04138-zMedications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studiesYu-Seon Jung0David Suh1Eunyoung Kim2Hee-Deok Park3Dong-Churl Suh4Sun-Young Jung5Chung-Ang University College of PharmacySchool of Public Health, University of MichiganChung-Ang University College of PharmacyChung-Ang University College of PharmacyRutgers, The State University of New Jersey School of PharmacyChung-Ang University College of PharmacyAbstract Background Medications influencing the risk of fall-related injuries (FRIs) in older adults have been inconsistent in previous guidelines. This study employed case–control design to assess the association between FRIs and medications, and an additional case-crossover design was conducted to examine the consistency of the associations and the transient effects of the medications on FRIs. Methods This study was conducted using a national claims database (2002–2015) in Korea. Older adults (≥ 65 years) who had their first FRI between 2007 and 2015 were matched with non-cases in 1:2 ratio. Drug exposure was examined for 60 days prior to the date of the first FRI (index date) in the case–control design. The hazard period (1–60 days) and two control periods (121–180 and 181–240 days prior to the index date) were investigated in the case-crossover design. The risk of FRIs with 32 medications was examined using conditional logistic regression after adjusting for other medications that were significant in the univariate analysis. In the case-crossover study, the same conditional model was applied. Results In the case–control design, the five medications associated with the highest risk of FRIs were muscle relaxants (adjusted odd ratio(AOR) = 1.35, 95% confidence interval (CI) = 1.31–1.39), anti-Parkinson agents (AOR = 1.30, 95%CI = 1.19–1.40), opioids (AOR = 1.23, 95%CI = 1.19–1.27), antiepileptics (AOR = 1.19, 95%CI = 1.12–1.26), and antipsychotics (AOR = 1.16, 95%CI = 1.06–1.27). In the case-crossover design, the five medications associated with the highest risk of FRIs were angiotensin II antagonists (AOR = 1.87, 95%CI = 1.77–1.97), antipsychotics (AOR = 1.63, 95%CI = 1.42–1.83), anti-Parkinson agents (AOR = 1.58, 95%CI = 1.32–1.85), muscle relaxants (AOR = 1.42, 95%CI = 1.35–1.48), and opioids (AOR = 1.35, 95%CI = 1.30–1.39). Conclusions Anti-Parkinson agents, opioids, antiepileptics, antipsychotics, antidepressants, hypnotics and sedatives, anxiolytics, muscle relaxants, and NSAIDs/antirheumatic agents increased the risk of FRIs in both designs among older adults. Medications with a significant risk only in the case-crossover analysis, such as antithrombotic agents, calcium channel blockers, angiotensin II antagonists, lipid modifying agents, and benign prostatic hypertrophy agents, may have transient effects on FRIs at the time of initiation. Corticosteroids, which were only associated with risk of FRIs in the case–control analysis, had more of cumulative than transient effects on FRIs.https://doi.org/10.1186/s12877-023-04138-zFall-related injuriesFall risk-increasing drugsClaims databaseCase–controlCase-crossover |
| spellingShingle | Yu-Seon Jung David Suh Eunyoung Kim Hee-Deok Park Dong-Churl Suh Sun-Young Jung Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies BMC Geriatrics Fall-related injuries Fall risk-increasing drugs Claims database Case–control Case-crossover |
| title | Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies |
| title_full | Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies |
| title_fullStr | Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies |
| title_full_unstemmed | Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies |
| title_short | Medications influencing the risk of fall-related injuries in older adults: case–control and case-crossover design studies |
| title_sort | medications influencing the risk of fall related injuries in older adults case control and case crossover design studies |
| topic | Fall-related injuries Fall risk-increasing drugs Claims database Case–control Case-crossover |
| url | https://doi.org/10.1186/s12877-023-04138-z |
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