Association Between Use of Multiple Psychoactive Medicines and Hospitalization for Falls: Retrospective Analysis of a Large Healthcare Claim Database

• Published in: Drug safety Vol. 37; no. 7; pp. 529 - 535
• Main Authors: Pratt, Nicole L., Ramsay, Emmae N., Kalisch Ellett, Lisa M., Nguyen, Tuan A., Barratt, John D., Roughead, Elizabeth E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2014; Adis International; Springer Nature B.V
• Subjects: Accidental Falls - statistics & numerical data; Aged, 80 and over; Antidepressants; Australia; Biological and medical sciences; Cohort Studies; Databases, Factual; Dose-Response Relationship, Drug; Drug dosages; Drug Safety and Pharmacovigilance; Drug Therapy, Combination; Drug toxicity and drugs side effects treatment; Drug Utilization Review; Female; Health services; Hospitalization; Hospitalization - statistics & numerical data; Humans; Injuries; Insurance Claim Review; Male; Medical sciences; Medicine; Medicine & Public Health; Mortality; Older people; Original; Original Research Article; Palliative care; Pharmacology. Drug treatments; Pharmacology/Toxicology; Psychotropic drugs; Psychotropic Drugs - administration & dosage; Psychotropic Drugs - adverse effects; Psychotropic Drugs - therapeutic use; Public health; Retrospective Studies; Risk factors; Toxicity: respiratory system, ent, stomatology; Veterans; Australia; Palliative Care; Fall Risk; Define Daily Dose; Residential Aged Care; Sedative Property; Human; Drug combination; Fall; Hospitalization; Psychotropic; Toxicity
• ISSN: 0114-5916; 1179-1942
• DOI: 10.1007/s40264-014-0179-2

Background Little is known about the impact of taking multiple psychoactive medicines on the risk of hospitalization for falls. Objective To identify the association between multiple psychoactive medicine use and hospitalization for falls. Methods A retrospective cohort study was conducted between July 2011 and June 2012 in the Australian veteran population who had been dispensed at least one psychoactive medicine within the previous year. Psychoactive medicines with sedative properties included antipsychotics, anxiolytics, hypnotics, antidepressants, opioids, anti-epileptics, anti-Parkinson medicines and medicines for migraine. The associations between falls and the number of psychoactive medicines used or the number of doses were analysed in comparison with falls that occurred when no psychoactive medicine was used. Results The adjusted results showed a significantly increased risk of falls when patients were on one or more psychoactive medicines or were receiving 0.1–0.9 defined daily dose (DDD) or more per day. The incident rate ratios (IRRs) were 1.22 (95 % confidence interval [CI] 1.08–1.38) for those on one psychoactive medicine, 1.70 (95 % CI 1.45–1.99) for those on two, 1.96 (95 % CI 1.58–2.43) for those on three or four, and 3.15 (95 % CI 1.90–5.23) for those on five or more. A similar result was observed when the data were analysed by dose, with the highest risk being found for those taking three or more DDD per day (adjusted IRR 4.26, 95 % CI 2.75–6.58). Conclusion Increased numbers or increased doses of psychoactive medicines are associated with an increased risk of hospitalization for falls in older adults. Strategies to reduce the psychoactive medicine burden are likely to translate into significant health benefits.