Falls in the stationary for patients with cardiovascular diseases of the senior age and polypharmacy
https://doi.org/10.17650/2222-8721-2018-8-3-19-27
Abstract
Background. The fall in the elderly is observed much more often than in younger people, and according to statistics the number of people over 65 years who have suffered a fall during the year reaches 30 %, while the probability of injury. Most of the falls in elderly patients does not lead to injury, but the developing at the same time unfavorable psychological discomfort can sharply limit the usual activity, lead to the formation of dependence on outside help, disadaptation in the home and form a fear of a possible fall. Falls, accompanied by the development of trauma, are observed in 10–15 % of cases.
The objective was to study the relationship between polymorbidity, polypragmasia and the development of the fall in elderly patients cardiological profile.
Results. Polymorbidity prevailed in the group of patients who suffered a fall in the hospital (8.9 ± 2.6 vs 7.5 ± 1.5 in men. 8.5 ± 2.2 vs 7.2 ± 1.6 in women). In patients undergoing a decline, it was also noted, and polypharmacy to a greater extent than cohort patients without falling (9.4 ± 1.9 vs 78.4 ± 2.2 in men. and 9.6 ± 2.7 vs 9.1 ± 2.5 for women). In addition, patients who suffered a fall in the hospital by age were older than patients in the comparison group (86 ± 6 vs 85 ± 5 in men, 87 ± 5 vs 84 ± 5 in women). We also revealed the tendency of the predominance of women in the subgroup of patients with the incidence and development of trauma.
Conclusion. Minimizing the amount of drugs received, as the fight against polypragmasy can help reduce the incidence of falls in elderly patients.
About the Authors
E. S. IlinaRussian Federation
Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993.
O. T. Bogova
Russian Federation
Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993.
I. I. Sinitsina
Russian Federation
Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993.
S. N. Puzin
Russian Federation
Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993.
D. A. Sychev
Russian Federation
Build. 1, 2 / 1 Barrikadnaya St., Moscow 125993.
References
1. United Nations. World Population Prospects. The 2017 Revision. Available at: https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_ KeyFindings.pdf.
2. [World Health Organization. 10 facts about aging and life path. Available at: http://www.who.int/features/factfiles/ageing/ageing_facts. (In Russ.)
3. Lazebnik L. B., Konev Yu. V., Drozdov B. N. Efremov L. I. Polypragmasia: Geriatric aspect of the problem. Consilium Medicum 2007;(12):29–34. (In Russ.)
4. [Ushkalova E. A., Tkacheva O. N., Runikhina N. K. et al. Features of pharmacotherapy in the elderly patients. Introduction to the problem. Ratsionalnaya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Radiology 2016;12(1):94–100. (In Russ.).
5. Garin N., Olaya B., Moneta M. V. et al. Impact of multimorbidity on disability and quality of life in the Spanish older population. PLoS One 2014;9(11):e111498. DOI: 10.1371/journal.pone.0111498. PMID: 25375890.
6. Federal State Statistics Service. Demographic prognosis for 2030. Available at: http://www.gks.ru/wps/wcm/connect/rosstat_main/rosstat/ru/statistics/population/demography/. (In Russ.
7. Sibley K. M., Voth J., Munce S. E. et al. Chronic disease and falls in communitydwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions. BMC Geriatr 2014;14:22. DOI: 10.1186/1471-2318-14-22. PMID: 24529293.
8. Vu T., Finch C. F., Day L. Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: a cluster analysis. BMC Geriatr 2011;11:45. DOI: 10.1186/1471-2318-11-45. PMID: 21851627.
9. Wu C., Bell C. M., Wodchis W. P. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments: a retrospective study. Drug Saf 2012;35 (9):769–81. DOI: 10.2165/11599540-000000000-00000. PMID: 22823502.
10. Nobili A., Licata G., Salerno F. et al. SIMI Investigators Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI Study. Eur J Clin Pharmacol 2011;67 (5):507–19. DOI: 10.1007/s00228-010-0977-0. PMID: 21221958.
11. Oliver D., Daly F., Martin F. C., McMurdo M. E. Risk factors and risk assessment tools for falls in hospital inpatients: a systematic review. Age Ageing 2004;33 (2):122–30. DOI: 10.1093/ ageing/afh017. PMID: 14960426.
12. Richardson K., Bennett K., Kenny R. A. Polypharmacy including falls riskincreasing medications and subsequent falls in community-dwelling middle-aged and older adults. Age Ageing 2015;44 (1):90–6. DOI: 10.1093/ageing/afu141. PMID: 25313240.
13. Tinetti M. E., Han L., Lee D. S. et al. Antihyprtensive medications and serious injuriesin a national representative sample of older adults. JAMA Intern Med 2014;174 (4):588–95. DOI: 10.1001/jamainternmed. 2013.14764. PMID: 24567036.
14. Woolcott J. C., Richardson K. J., Wiens M. O. et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009;169 (21):1952–60. DOI: 10.1001/archinternmed.2009.357. PMID: 19933955.
15. Belaya Zh. E., Rozhinskaya L. Ya. Falls as an important social problem of the elderly: main mechanisms of development and ways of prevention. Rossiyskiy meditsinskiy zhurnal = Russian Medical Journal 2009;17 (24):1614–21. (In Russ.)
16. [Falls. Fact Sheet of the World Health Organization. August 2017. Available at: http://www.who.int/mediacentre/factsheets/fs344/ru/. (In Russ.)].
17. Cameron I. D., Chen J. S., March L. M. et al. Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: a prospective 5-year study. J Bone Miner Res 2010;25 (4):866–72. DOI: 10.1359/jbmr.091029. PMID: 19839771.
18. Vestergaard P., Rejnmark L., Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and postfracture complications. Osteoporos Int 2007;18 (12):1583–93. DOI: 10.1007/s00198-007-0403-3. PMID: 17566814.
19. Gladkova E. N., Khodyrev V. N., Lesnyak O. M. Analysis of the state of medical care and outcomes for patients with proximal femoral fracture (populational study data). Osteoporoz i osteopatii = Osteoporosis and Bone Diseases 2011; (3):7–10. (In Russ.).
20. von Lueder T. G., Atar D. Comorbidities and polypharmacy. Heart Fail Clin 2014;10 (2):367–72. DOI: 10.1016/j.hfc.2013.12.001. PMID: 24656112.
21. Скрипникова И. А. Падения – важный фактор риска переломов: причины и способы профилактики. Consilium medicum 2014; (6):28–33.
22. Baranzini F., Diurni M., Ceccon F. et al. Fall-related injuries in a nursing home setting: Is polypharmacy a risk factor? BMC Health Serv Res 2009;9:228. DOI: 10.1186/1472-6963-9-228. PMID: 20003327.
23. Glab K. L., Wooding F. G., Tuiskula K. A. Medication-related falls in the elderly: mechanisms and prevention strategies. Consult Pharm 2014;29(6):413–7. DOI: 10.4140/TCP.n.2014.413. PMID: 25202895.
24. Kojima T., Akishita M., Nakamura T. et al. Association of polypharmacy with fall risk among geriatric outpatients. Geriatr Gerontol Int 2011;11 (4):438–44. DOI: 10.1111/j.1447-0594.2011.00703.x. PMID: 21545384.
25. Pan H. H., Li C. Y., Chen T. J. et al. Association of polypharmacy with fallrelated fractures in older Taiwanese people: age- and gender-specific analyses. BMJ Open 2014;4(3):e004428. DOI: 10.1136/bmjopen-2013-004428. PMID: 24682575.
26. Vu T., Day L., Finch C. F. The burden of hospitalised fall-related injury in community-dwelling older people in Victoria: a database study. Aust N Z J Public Health 2014;38 (2):128–33. DOI: 10.1111/1753-6405.12156. PMID: 24690050.
27. Moncada L. V. V., Mire L. G. Preventing falls in older persons. Am Fam Physician 2017;96 (4):240–7. PMID: 28925664.
28. The American Geriatrics Society. AGS/ BGS clinical practice guideline: prevention of falls in older person (2010). Available at: http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/.
Review
For citations:
Ilina E.S., Bogova O.T., Sinitsina I.I., Puzin S.N., Sychev D.A. Falls in the stationary for patients with cardiovascular diseases of the senior age and polypharmacy. Neuromuscular Diseases. 2018;8(3):19-27. (In Russ.) https://doi.org/10.17650/2222-8721-2018-8-3-19-27