title: Psychological well-being is an independent predictor of falling in an 8-year follow-up of older adults. Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study. Identification of high risk fallers among older people living in residential care facilities: a simple screen based on easily collectable measures. Physician–Patient Communication About Prescription Medication Nonadherence: A 50-state Study of America’s Seniors Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. Central nervous system medications and falls risk in men aged 60-75 years: the Study on Male Osteoporosis and Aging (SOMA). Falls risk among a very old home-dwelling population Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. Risk factors for falls among elderly persons living in the community. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Associations between drug burden index and falls in older people in residential aged care. Falls in very old people: the population-based Umeå 85+ study in Sweden. Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE). Angiotensin system-blocking medications are associated with fewer falls over 12 months in community-dwelling older people.
abstract: A population -based sample ( N = 787 ) was followed for 8 years and assessed three times on measures of well-being ( depressive symptoms , morale , and control ) and fall history . Marginal models assessed the association between baseline well-being measures and falling . R and om effects models assessed change in well-being indicators as well as change in fall rate over 8 years . After adjustment for sociodemographics , psychotropic medication , health , and sensorimotor function , our results showed that depressive symptoms , control , and morale were risk factors for subsequent falling , and an increase in depressive symptoms or a reduction in morale was associated with an increasing fall rate . We conclude that the three well-being measures are independently associated with falling and need to be considered in fall-risk assessment s and population -based prevention and intervention strategies AIM To determine the prevalence of potentially suboptimal medication use and association with adverse outcomes . METHODS A prospect i ve , observational cohort study of 4260 community-dwelling older men from Perth , Western Australia ( mean age of 77 ± 3.6 years ) was conducted . Follow-up was for 4.5 years ( or until death , if sooner ) . Cox proportional hazard models were used to explore associations between suboptimal medication use and prospect i ve clinical outcomes . Logistic regression analyses were used to explore predictors of a fall in the previous 12 months . RESULTS Use of potentially inappropriate medicines  ( 48.7 % ) , polypharmacy ( ≥5 medications , 35.8 % ) and potential under-utilization ( 56.7 % ) were highly prevalent , and overall 82.3 % of participants reported some form of potentially suboptimal medication use . A self-reported history of falls in the previous 12 months was independently associated with the number of medicines taken ( odds ratio [OR]= 1.06 , 95 % confidence interval [ CI ] 1.02 , 1.09 ) and use of one or more potentially inappropriate medicines ( OR = 1.23 , 95 % CI 1.04 , 1.45 ) . After adjusting for age , co-morbidity , smoking status , body mass index , hypertension and educational attainment , the number of medicines reported was associated with admission to hospital ( hazard ratio [HR]= 1.04 , 95 % CI 1.03 , 1.06 ) , cardiovascular events ( HR = 1.09 , 95 % CI 1.06 , 1.12 ) and all cause mortality ( HR = 1.04 , 95 % CI 1.00 , 1.07 ) . Use of one or more potentially inappropriate medicines was associated with admission to hospital ( HR = 1.16 , 95 % CI 1.08 , 1.24 ) . Potential under-utilization was associated with cardiovascular events ( HR = 1.20 , 95 % CI 1.03 , 1.40 ) . CONCLUSIONS These data suggest that both medication over-use and under-use occur frequently among older men and may be harmful PURPOSE To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls . METHODS This prospect i ve study was conducted in seven residential care facilities in the U.K. Residents aged>60 years who were not bedbound or terminally ill participated .  Demographics , medical history , medication use , cognition ( mini mental state examination ( MMSE ) ) , function ( Barthel , balance and sit-to-st and ability ) and behavior ( neuro-psychiatric inventory ( NPI ) and impulsivity ) were recorded at baseline . Falls and injuries were prospect ively recorded over 6 months . Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis . RESULTS Two hundred and forty residents completed the study . In the follow-up period , 50 % fell ≥1 times . Fallers had worse function , cognition , behavior and balance and took more medications . Falling in the past year , walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling . Logistic regression identified MMSE<17 , impulsivity score ≥ 2 , st and ing balance score<6 , requiring a walking frame , falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls . The area under the receiver operating curve ( ROC ) for this model was 0.79 ( 95 % CI 0.73 - 0.84 ) . CONCLUSIONS This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period . The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group Context Underst and ing and improving the quality of medication management is particularly important in the context of the Medicare prescription drug benefit that took effect last January 2006 . Objective To determine the prevalence of  physician – patient dialogue  about  medication cost and medication adherence among elderly adults nationwide . Design Cross-sectional survey . Participants National stratified r and om sample of community-dwelling Medicare beneficiaries aged 65 and older . Main Outcome Measures Rates of physician – patient dialogue about nonadherence and cost-related medication switching . Results Forty-one percent of seniors reported taking five or more prescription medications , and more than half has 2 or more prescribing physicians . Thirty-two percent overall and 24 % of those with 3 or more chronic conditions reported not having talked with their doctor about all their different medicines  in the last 12 months . Of seniors reporting skipping doses or stopping a medication because of side effects or perceived nonefficacy , 27 % had not talked with a physician about it . Of those reporting cost-related nonadherence , 39 % had not talked with a physician about it . Thirty-eight percent of those with cost-related nonadherence reported switching to a lower priced drug , and in a multivariable model , having had a discussion about drug cost was significantly associated with this switch ( odds ratio [ OR ] 5.04 , 95 % confidence interval [ CI ] 4.28–5.93 , P < .001 ) . Conclusions We show that there is a communication gap between seniors and their physicians around prescription medications . This communication problem is an important quality and safety issue , and takes on added salience as physicians and patients confront new challenges associated with coverage under new Medicare prescription drug plans . Meeting these challenges will require that more attention be devoted to medication management during all clinical encounters The prevention of injury associated with falls in older people  is a public health target in many countries around the world . Although there is good evidence that interventions such as multifactorial fall prevention and individually prescribed exercise are effective in reducing falls , the effect on serious injury rates is unclear . Historically , trials have not been adequately powered to detect injury endpoints , and variations in case definition across trials have hindered meta- analysis . It is possible that fall-prevention strategies have limited effect on falls that result in injuries or are ineffective in population s who are at a higher risk of injury . Further research is required to determine whether fall-prevention interventions can reduce serious injuries . Prevention of Falls Network Europe ( ProFaNE ) is a collaborative project to reduce the burden of fall injury in older people through excellence in research and promotion of best practice ( www.profane.eu.org ) . The European Commission funds the network , which links clinicians , members of the public , and research ers worldwide . The aims are to identify major gaps in knowledge in fall injury prevention and to facilitate the collaboration necessary for large-scale clinical research activity , including clinical trials , comparative research , and prospect i ve meta- analysis . Work is being undertaken in a 4-year program . As a first step , the development of a common set of outcome definitions and measures for future trials or meta- analysis was considered INTRODUCTION drugs acting on the central nervous system ( CNS ) increase falls risk . Most data on CNS drugs and falls are in women/mixed-sex population s. This study assessed the relationship between  CNS drugs  and  falls in men aged 60 - 75 years . METHODS a question naire was sent to r and omly selected Danish men aged 60 - 75 years . Cross-sectional data on CNS drugs and falls in the previous year were available for 4,696 men . Logistic regression investigated the relationship between falls and CNS drugs .  RESULTS the median age was 66.3 ( IQR = 63.1 - 70.0 ) years ; 21.7 % were fallers . The following were associated with fallers ( OR ; 95 % CI ) : opiates ( 2.4 ; 1.5 - 3.7 ) , other analgesics ( 1.7 ; 1.4 - 2.1 ) , antiepileptics ( 2.8 ; 1.5 - 5.1 ) , antidepressants ( 2.8 ; 1.9 - 4.1 ) and anxiolytics/hypnotics ( 1.5 ; 0.9 - 2.6 ) . Effects of opiates interacted strongly and significantly with age , with a marked association with falls in the older half of the subjects only . No significant associations were found between antipsychotics and fallers . Selective serotonin reuptake inhibitors and tricyclics were significantly associated with fallers ( 3.1 ; 2.0 - 5.0 and 2.2 ; 1.0 - 4.7 , respectively ) . CONCLUSION several CNS drug classes are associated with an approximately 2 - 3-fold increase risk of falls in men aged 60 - 75 years r and omly selected from the population . Further longitudinal data are now required to confirm and further investigate the role of CNS drugs in falls causation in men Objective . The aim of this prospect i ve study was to examine risk factors of falling in a very old home-dwelling population . Design . A prospect i ve study of home-dwelling elderly people . Methods . Baseline data were collected by home-nursing staff through postal question naires and clinical tests . Data on falls were recorded in telephone interviews every other month during a follow-up of 11 months constituting 494 person years ( PY ) . Negative binomial modeling was used to assess fall risk . Setting . General community . Subjects . A population sample of home-dwelling subjects aged 85 years or older ( n = 555 ) . Main outcome measures . Fall rate and risk factors of falls . Results . Altogether 512 falls occurred in 273 ( 49 % ) subjects , incidence rate 1.03/PY . According to a multivariate model , history of recurrent falling , trouble with vision when moving , use of antipsychotic drug , and feelings of anxiety , nervousness , or fear were independent risk factors for subsequent falls . Conclusion . Appropriate care of poor vision and feelings of anxiety , nervousness , or fear , and avoidance of use of antipsychotic drugs might be useful in the prevention of falls among the most elderly home-dwellers OBJECTIVES Determine the cognitive effect , safety , and tolerability of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence . DESIGN R and omized , double-blinded , placebo-controlled trial . SETTING Twelve skilled nursing homes . PARTICIPANTS Fifty women aged 65 and older with urge incontinence and cognitive impairment . INTERVENTION Four-week treatment with once-daily oral extended-release oxybutynin 5 mg or placebo . MEASUREMENTS Withdrawal rates and delirium or change in cognition from baseline at 1 , 3 , 7 , 14 , 21 , and 28 days after starting treatment using the Confusion Assessment Method ( CAM ) , Mini-Mental State Examination ( MMSE ) , and Severe Impairment Battery ( SIB ) . The Brief Agitation Rating Scale , adverse events , falls incidence , and serum anticholinergic activity change with treatment were also assessed . RESULTS Participants ' mean age + /-st and ard deviation was 88.6+/-6.2 , and MMSE baseline score was 14.5+/-4.3 . Ninety-six percent of subjects receiving oxybutynin ( n=26 ) and 92 % receiving placebo ( n=24 ) completed treatment ( P=.50 ) . The differences in mean change in CAM score from baseline to all time points were equivalent between the oxybutynin and placebo groups . Delirium did not occur in either group . One participant receiving oxybutynin was withdrawn because of urinary retention , which resolved without treatment . Mild adverse events occurred in 38.5 % of participants receiving oxybutynin and 37.5 % receiving placebo ( P=.94 ) . CONCLUSION Short-term treatment using oral extended-release oxybutynin 5 mg once daily was safe and well tolerated , with no delirium , in older female nursing home participants with mild to severe dementia . Future research should investigate different dosages and long-term treatment To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling STUDY OBJECTIVES We sought to document the degree of polypharmacy , the frequency of adverse drug-related events ( ADREs ) leading to emergency department presentation that were recognized by emergency physicians , and the frequency of potential adverse drug interactions ( PADIs ) in medication regimens of elderly patients in the ED . METHODS We conducted a retrospective chart review on 300 r and omly selected ED visits made by patients 65 years of age and older between January 1 and December 31 , 1998 . ADREs were defined according to a st and ardized algorithm . PADIs were identified by using the drug interaction data base PharmVigilance . RESULTS After excluding 17 patient visits with inadequate documentation , 283 were left for review . Of these , 257 ( 90.8 % ) patients were taking 1 or more medications ( prescribed or over the counter ) . The number of medications consumed ranged from 0 to 17 and averaged 4.2 ( SD+/-3.1 ) drugs per patient . ADREs accounted for 10.6 % of all ED visits in our patient group . The most frequently implicated classes of medications were nonsteroidal anti-inflammatory drugs , antibiotics , anticoagulants , diuretics , hypoglycemics , beta-blockers , calcium-channel blockers , and chemotherapeutic agents . Thirty-one percent of all patients in our group had at least 1 PADI in their medication list . Among patients who presented because of an ADRE , 50 % had at least 1 PADI in their medication list that was unrelated to the ADRE with which they presented . CONCLUSION ADREs are an important cause of ED presentation in the elderly . PADIs are found in a significant proportion of medication lists . Emergency physicians must be vigilant in monitoring elderly patients for medication-related problems OBJECTIVES To evaluate the association between the Drug Burden Index ( DBI ) , a measure of a person 's total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people , and falls in residents of residential aged care facilities ( RACFs ) . DESIGN Data were drawn from participants in a r and omized controlled trial that investigated falls and fractures . SETTING RACFs in Sydney , Australia . PARTICIPANTS Study participants ( N=602 ; 70.9 % female ) were recruited from 51 RACFs . Mean age was 85.7 ± 6.4 , and mean DBI was 0.60 ± 0.66 . MEASUREMENTS Medication history was obtained on each participant . Drugs were classified as anticholinergic or sedative and a DBI was calculated . Falls were measured over a 12-month period . Comorbidity , cognitive impairment ( Mini-Mental State Examination ) and depression ( Geriatric Depression Scale ) were determined . RESULTS There were 998 falls in 330 individuals during a follow-up period of 574.2 person-years , equating to an average rate of 1.74 falls per person-year . The univariate negative binomial regression model for falls showed incidence rate ratios of 1.69 ( 95 % confidence interval (CI)=1.22 - 2.34 ) for low DBI ( < 1 ) and 2.11 ( 95 % CI=1.47 - 3.04 ) for high DBI ( ≥1 ) when compared with those who had a DBI of 0 . After adjusting for age , sex , history of falling , cognitive impairment , depression , use of a walking aid , comorbidities , polypharmacy , and incontinence , incident rate ratios of 1.61 ( 95 % CI=1.17 - 2.23 ) for low DBI and 1.90 ( 95 % CI=1.30 - 2.78 ) for high DBI were obtained . CONCLUSION DBI is significantly and independently associated with falls in older people living in RACFs . Interventional studies design ed for this population are needed to determine whether reducing DBI , through dose reduction or cessation of anticholinergic and sedative drugs , can prevent falls The aim of this study was to describe incidences of falls and fall-related injuries , and to identify predisposing factors for falls in very old people in a prospect i ve population -based follow-up study for falls . The study is part of the Umeå 85 + Study which includes half of the population aged 85 , and the total population aged 90 and > or = 95 ( -103 ) , in Umeå , Sweden . Of the 253 people interviewed , 220 ( 87 % ) were followed up for  falls for 6 months , of whom 109 lived in ordinary and 111 in institutional housing . A comprehensive geriatric baseline assessment was made through interviews and testing during home visits . Forty percent of the participants did fall a total 304 times , corresponding to 2.17 falls per Person Year ( PY ) . It occurred 0.83 injuries per PY , including 0.14 fractures per PY . In a Cox regression analysis , the independent explanatory risk factors for time to first fall were dependency in activities of daily living ( ADL ) , thyroid disorders , treatment with selective serotonin reuptake inhibitors ( SSRIs )  and occurrence of falls in the preceding year . It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year . ADL , thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric in patients and develop a screening tool to accurately predict falls . The study sample consisted of 225 geriatric-psychiatric in patients at a Midwestern referral facility . The sample included 136 in patients who fell and a r and om stratified sample of 89 in patients who did not fall . Data collected included age , gender , activities of daily living , and nursing parameters such as bathing assistance , bed height , use of bed rails , one-on-one observation , fall warning system , Conley Scale fall risk assessment , medical diagnosis , and medications . History of falls , impaired judgment , impaired gait , dizziness , delusions , delirium , chronic use of sedative or antipsychotic agents , and anticholinergic urinary bladder medications significantly increased fall risk . Alzheimer 's disease , acute use of sedative or anti-psychotic agents , and depression reduced fall risk . A falls risk tool , Fall Risk Assessment in Geriatric-psychiatric In patients to Lower Events ( FRAGILE ) , was developed for assessment and risk stratification with new diagnoses or medications OBJECTIVES To investigate relationships between the use of cardiovascular medications , including angiotensin system-blocking medications ( ASBMs ) , orthostatic hypotension ( OH ) , fall risk , and falls in community-dwelling older people . DESIGN Prospect i ve cohort study . SETTING Sydney , Australia . PARTICIPANTS Five hundred twenty community-dwelling older adults . MEASUREMENTS Medical , medication and falls history were obtained from a st and ardized question naire in all participants . Blood pressure was measured in supine , seated , and tilted positions . Fall risk was assessed using the Physiological Profile Assessment ( PPA ) . Falls data were collected prospect ively for 12 months using monthly fall calendars . Participants were defined as nonfallers ( no falls ) and fallers ( ≥ 1 falls ) at the end of the 12-month follow-up . RESULTS Participants taking medications affecting the angiotensin system had greater quadriceps strength , but after adjusting for sex , this difference became insignificant . People taking ASBMs were less likely to fall ( odds ratio = 0.68 , 95 % confidence interval = 0.48 - 0.97 ) , and the association between ASBMs and falls remained significant after adjusting for sex , body mass index , PPA score , and psychotropic medication and 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitor ( statin ) use . OH was more frequently observed in participants taking alpha adrenergic receptor blockers ( α-blockers ) , but the presence of OH did not increase fall risk . CONCLUSION The use of cardiovascular medications in older people did not increase the risk of falls , and the use of ASBMs was associated with lower fall risk . The mechanisms for this apparent protective effect are unclear and appear not to be directly related to muscle strength . More research is required to eluci date the possible protective effects of certain cardiovascular medications in relation to falls in older people
target: Conclusions The use of sedatives and hypnotics and antidepressants including tricyclic antidepressants , selective serotonin reuptake inhibitors , and serotonin norepinephrine reuptake inhibitors appears to be related with an increased risk of falls .
  It is not clear if the use of antihypertensive medications is associated with the risk of falls in older people
background: Purpose Falls are an important public health problem in older people .
  Medication use is considered a risk factor for falls .
  This study systematic ally review ed recent studies to determine the medications that might be associated with the risk of falling in older people .