Sains Malaysiana 49(6)(2020): 1381-1388

http://dx.doi.org/10.17576/jsm-2020-4906-16

The Use of Fall Risk-Increasing Drugs among Older People in Nursing Homes

(Penggunaan Ubatan yang Meningkatkan Risiko Jatuh dalam Kalangan Warga Tua di Rumah Penjagaan)

LEE SHIOW LING, MARHANIS OMAR*, ADLIAH MHD-ALI & MOHD MAKMOR-BAKRY

Faculty of Pharmacy, National University of Malaysia, Jalan Raja Muda Abdul Aziz, 53000 Kuala Lumpur, Federal Territory, Malaysia

Diserahkan: 18 Mac 2019/ Diterima: 14 Februari 2020

ABSTRACT

Medication use is one of the modifiable risk factors that causes falls. Falls are the leading cause of injury among elderly people. The incidence of falls does significantly impact elderly people‘s independence in carrying out their regular activities. This study aimed to determine the prevalence of drugs that cause falls and the fall risk status among elderly people residing in nursing homes. A cross-sectional study was conducted on residents in 27 long term care facilities in Malaysia from March 2018 until November 2018 using a researcher-assisted questionnaire. A total of 212 residents were recruited in this study. A majority of the residents were taking at least one fall-risk increasing drug (FRIDs) or orthostatic drug (ODs) (n=145, 68.4%), with two-thirds of them presenting high risk of falling (n=95, 65.5%). A significant association was found between the use of beta-blocking agents (p=0.033), renin-angiotensin system inhibitors (p=0.038), length of stay in facilities (p=0.031), frailty status (p<0.001), number of drugs in total (p=0.010) and as needed (p=0.025) with an increased risk of falls. Therefore, a majority of the elderly people residing in nursing homes were proven to be prone to the use of fall-risk medications. Frail elderly people have a higher risk of falling compared to those who were non-frail.

Keywords: Drug use; polypharmacy; side-effect

ABSTRAK

Penggunaan ubat merupakan salah satu faktor risiko yang terubahsuai yang menyebabkan jatuh. Jatuh adalah penyebab utama kecederaan dalam kalangan warga tua. Ini akan memberi kesan kepada warga tua dalam menjalankan aktiviti lazim mereka. Kajian ini bertujuan untuk menentukan ubat-ubatan yang memberi risiko yang menyebabkan jatuh dalam kalangan warga tua yang berada di rumah penjagaan. Satu kajian rentas telah dijalankan dalam kalangan penghuni di 27 rumah penjagaan di Malaysia bermula dari bulan Mac 2018 hingga November 2018 menggunakan borang soal selidik. Seramai 212 penghuni terlibat dalam kajian ini. Majoriti penghuni didapati mengambil sekurang-kurangnya satu ubat yang mempunyai risiko untuk jatuh (FRID) atau ubat ortostatik (OD) (n = 145, 68.4%), dengan dua pertiga daripada mereka mempunyai risiko jatuh yang tinggi (n = 95, 65.5%). Satu kaitan yang penting antara penggunaan agen penghalang beta (p = 0.033), perencat sistem renin-angiotensin (p = 0.038), tempoh berada di rumah penjagaan (p = 0.031), status kelemahan (p <0.001), jumlah ubatan yang diambil secara keseluruhan (p = 0.010) dan jumlah ubatan yang diambil bila perlu (p = 0.025) dengan peningkatan risiko untuk jatuh. Oleh itu, majoriti warga tua yang tinggal di rumah penjagaan terdedah kepada penggunaan ubat yang mempunyai risiko untuk jatuh. Warga tua yang mempunyai sindrom lemah juga mempunyai risiko yang lebih besar untuk jatuh berbanding mereka yang tidak lemah.

Kata kunci: Kesan sampingan; penggunaan ubat; polifarmasi

RUJUKAN

Butt, D., Mamdani, M., Austin, P., Tu, K., Gomes, T. & Glazier, R. 2013. The risk of falls on initiation of antihypertensive drugs in the elderly. Osteoporosis International 24(10): 2649-2657.

Cheng, Y.Z., Huang, Z.Z., Shen, Z.F., Wu, H.Y., Peng, J.X., Waye, M.M.Y., Rao, S.T. & Yang, L. 2017. Ace inhibitors and the risk of fractures: A meta-analysis of observational studies. Endocrine 55(3): 732-740.

Cullinan, S., O'mahony, D., O'Sullivan, D. & Byrne, S. 2016. Use of a frailty index to identify potentially inappropriate prescribing and adverse drug reaction risks in older patients. Age and Ageing 45(1): 115-120.

Frankenstein, L., Nelles, M., Slavutsky, M., Schellenberg, D., Boesch, A., Katus, H., Remppis, A. & Zugck, C. 2007. Beta-blockers influence the short-term and long-term prognostic information of natriuretic peptides and catecholamines in chronic heart failure independent from specific agents. Journal of Heart and Lung Transplantation 26(10): 1033-1039.

Ghazi, H.F., Elnajeh, M., Abdalqader, M.A., Baobaid, M.F., Rosli, N.S.R. & Syahiman, N.   2017. The prevalence of falls and its associated factors among elderly living in old folks home in Kuala Lumpur, Malaysia. International Journal of Community Medicine and Public Health 4(10): 3524-3529.

Gribbin, J., Hubbard, R., Gladman, J., Smith, C. & Lewis, S. 2011. Risk of falls associated with antihypertensive medication: Self-controlled case series. Pharmacoepidemiology and Drug Safety 20(8): 879-884.

Kuschel, B.M., Laflamme, L. & Möller, J. 2015. The risk of fall injury in relation to commonly prescribed medications among older people - a Swedish case-control study. European Journal of Public Health 25(3): 527-532.

Lipsitz, L.A., Habtemariam, D., Gagnon, M., Iloputaife, I., Sorond, F., Tchalla, A.E., Dantoine, T.F. & Travison, T.G. 2015. Reexamining the effect of antihypertensive medications on falls in old age.  Hypertension 66(1): 183-189.

Milos, V., Bondesson, Å., Magnusson, M., Jakobsson, U., Westerlund, T. & Midlöv, P. 2014. Fall risk-increasing drugs and falls: A cross-sectional study among elderly patients in primary care. BMC Geriatrics 14(1): 40.

Morley, J.E., Malmstrom, T.K. & Miller, D.K. 2012. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. The Journal of Nutrition, Health & Aging 16(7): 601-608.

Nizaruddin, M.A., Omar, M.S., Mhd-Ali, A. & Makmor-Bakry, M. 2017. A qualitative study exploring issues related to medication management in residential aged care facilities. Patient Preference and Adherence 11: 1869-1877

Pi, H.Y., Hu, M.M., Zhang, J., Peng, P.P. & Nie, D. 2015. Circumstances of falls and fall-related injuries among frail elderly under home care in China. International Journal of Nursing Sciences 2(3): 237-242.

Rubenstein, L.Z., Vivrette, R., Harker, J.O., Stevens, J.A. & Kramer, B.J. 2011. Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults. Journal of Safety Research 42(6): 493-499.

Ryan-Atwood, T.E., Hutchinson-Kern, M., Ilomäki, J., Dooley, M.J., Poole, S.G., Kirkpatrick, C.M., Manias, E., Mitra, B. & Bell, J.S. 2017. Medication use and fall-related hospital admissions from long-term care facilities: A hospital-based case-control study.  Drugs & Aging 34(8): 625-633.

Tchalla, A.E., Lachal, F., Cardinaud, N., Saulnier, I., Bhalla, D., Roquejoffre, A., Rialle, V., Preux, P.M. & Dantoine, T. 2012. Efficacy of simple home-based technologies combined with a monitoring assistive center in decreasing falls in a frail elderly population (results of the Esoppe study). Archives of Gerontology and Geriatrics 55(3): 683-689.

van der Velde, N., Stricker, B.H.C., Pols, H.A. & van der Cammen, T.J. 2007. Withdrawal of fall-risk-increasing drugs in older persons. Drugs & Aging 24(8): 691-699.

*Pengarang untuk surat-menyurat; email: marhanis@ukm.edu.my