Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial

被引：60

作者：

Boye, Nicole D. A. ^{[1
,2
]}

van der Velde, Nathalie ^{[1
]}

de Vries, Oscar J. ^{[3
]}

van Lieshout, Esther M. M. ^{[2
]}

Hartholt, Klaas A. ^{[1
,2
]}

Mattace-Raso, Francesco U. S. ^{[1
]}

Lips, Paul ^{[3
]}

Patka, Peter ^{[4
]}

van Beeck, Ed F. ^{[5
]}

van der Cammen, Tischa J. M. ^{[1
]}

机构：

[1] Univ Med Ctr Rotterdam, Sect Geriatr Med, Dept Internal Med, Erasmus MC, Rotterdam, Netherlands

[2] Univ Med Ctr Rotterdam, Dept Surg Traumatol, Erasmus MC, Rotterdam, Netherlands

[3] Vrije Univ Amsterdam, Med Ctr, Dept Internal Med, Amsterdam, Netherlands

[4] Univ Med Ctr Rotterdam, Erasmus MC, Dept Emergency Med, Rotterdam, Netherlands

[5] Univ Med Ctr Rotterdam, Dept Publ Hlth, Erasmus MC, Rotterdam, Netherlands

来源：

AGE AND AGEING | 2017年 / 46卷 / 01期

关键词：

older people; RCT; FRIDs; drugs; withdrawal; falls; INCREASING DRUGS; INJURIOUS FALLS; PEOPLE; METAANALYSIS; CARE; INTERVENTION; POPULATION; PREVENTION; IMPACT;

D O I：

10.1093/ageing/afw161

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

030301 [社会学]; 100201 [内科学];

摘要：

Objectives: to investigate the effect of withdrawal of fall-risk-increasing-drugs (FRIDs) versus 'care as usual' on reducing falls in community-dwelling older fallers. Design: randomised multicentre trial. Participants: six hundred and twelve older adults who visited an Emergency Department (ED) because of a fall. Interventions: withdrawal of FRIDs. Main Outcomes and Measures: primary outcome was time to the first self-reported fall. Secondary outcomes were time to the second self-reported fall and to falls requiring a general practitioner (GP)-consultation or ED-visit. Intention-to-treat (primary) and a per-protocol (secondary) analysis were conducted. The hazard ratios (HRs) for time-to-fall were calculated using a Cox-regression model. Differences in cumulative incidence of falls were analysed using Poisson regression. Results: during 12 months follow-up, 91 (34%) control and 115 (37%) intervention participants experienced a fall; 35% of all attempted interventions were unsuccessful, either due to recurrence of the initial indication for prescribing, additional medication for newly diagnosed conditions or non-compliance. Compared to baseline, the overall percentage of users of = 3 FRIDs at 12 months did not change in either the intervention or the control group. Our intervention did not have a significant effect on time to first fall (HR 1.17; 95% confidence interval 0.89-1.54), time to second fall (1.19; 0.78-1.82), time to first fall-related GP-consultation (0.66; 0.42-1.06) or time to first fall-related ED-visit (0.85; 0.43-1.68). Conclusion: in this population of complex multimorbid patients visiting an ED because of a fall, our single intervention of FRIDs-withdrawal was not effective in reducing falls. Conclusion: in this population of complex multimorbid patients visiting an ED because of a fall, our single intervention of FRIDs-withdrawal was not effective in reducing falls.

引用

页码：142 / 146

页数：6

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