Falls in elderly patients with comorbidity, which were prescribed combined application of psychotropic and cardiovascular medicines

The article discusses aspects of drug-induced falls in elderly comorbid patients against the background of polypragmasy and also assesses the role of drug interactions that are highly dangerous according to the risk of falling. A drug audit of the obtained pharmacotherapy database was performed in patients with comorbid pathology older than 75 years, in order to identify fall-risk-increasing drugs, ranked according to the degree of risk of falling, their significant interactions and with using the traffic light classification. The data on the analysis of the contribution of psychotropic, cardiological drugs and their combination on the risk of developing a fall in the hospital in comorbid patients of old age against polypragmasy are presented.

1. Fastbom J., Johnell K. National indicators for quality of drug therapy in older persons: the Swedish experience from the first 10 years. Drugs Aging 2015; 32(3):189–99. PMID: 25673123. DOI: 10.1007/s40266-015-0242-4.

2. Le Couteur D.G., McLachlan A.J., de Cabo R. Aging, drugs and drug metabolism. J Gerontol A Biol Sci Med Sci 2012;67(2):137–9. PMID: 21768500. DOI: 10.1093/gerona/glr084.

3. Milos V., Bondesson A., Magnusson M. et al. Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care. BMC Geriatrics 2014;14:40. PMID: 24674152. DOI: 10.1186/1471-2318-14-40.

4. Lee J., Choi M., Kim C.O. Falls, a Fear of Falling, and related Factors in Older Adults with Complex Chronic Disease. J Clin Nursing 2017;26;23–4. PMID: 28793363. DOI: 10.1111/jocn.13995.

5. Falls. World Health Organization newsletter(january 2018). Available at: http://www.who.int/ru/newsroom/fact-sheets/detail/falls. (In Russ.).

6. Park H., Satoh H., Miki A. et al. Medications associated with falls in older people: systematic review of publications from a recent 5-year period. Eur J Clin Pharmacol 2015;71(12):1429–40. PMID: 26407688. DOI: 10.1007/s00228-015-1955-3.

7. Ming Y., Zecevic A. Medications and polypharmacy influence on recurrent fallers in community: a systematic review. Canadian Geriatr J 2018;26;21(1):14–25. PMID: 29581817. DOI: 10.5770/cgj.21.268.

8. Ambrose A.F., Paul G., Hausdorff J.M. Risk factors for falls among older adults: a review of the literature. Maturitas 2013;75(1):51–61. PMID: 23523272. DOI: 10.1016/j.maturitas.2013.02.009.

9. Tinetti M.E., Speechley M., Ginter S.F. Risk factors for fallsamong elderly persons living in the community. N Engl J Med 1988;319:1701–7. PMID: 3205267. DOI: 10.1056/NEJM198812293192604.

10. De Vries M., Seppala L.J., Daams J.G. et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: I. Cardiovascular drugs. J Am Med Dir Assoc 2018;19(4):371.e1–9. PMID: 29396189. DOI: 10.1016/j.jamda.2017.12.013.

11. Seppala L.J., Wermelink A.M., de Vries M. et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics. J Am Med Dir Assoc 2018;19(4):371.e11–7. PMID: 29402652. DOI: 10.1016/j.jamda.2017.12.098.

12. Seppala L.J., van de Glind E.M.M., Daams J.G. et al. Fall-risk-increasing drugs: a systematic review and metaanalysis: III. Others. J Am Med Dir Assoc 2018;19(4):372.e1–8. PMID: 29402646. DOI: 10.1016/j.jamda.2017.12.099.

13. Darowski A., Dwight J., Reynolds J. Medicines and falls in hospital: guidance sheet. National Institute for Health and Clinical Excellence guidelines, 2011. Available at: http://www.drugsandfalls.com.

14. Sjchev D.A., Zhuchkov A.V., Bogova O.T., Ilina E.S. Falls of elderly and senile patients: the contribution of drugs. Klinicheskaya Gerontologiya = Clinical Gerontology 2017;23:56–64. (In Russ.).

15. National Health Service. Guidance Sheet 5. Caring for Care Homes: drugs and falls, 2015. Available at: https://www.newdevonccg.nhs.uk/file/?rid=116549.

16. Gnjidic D., Hilmer S.N., Blyth F.M. et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 2012;65(9):989–95. PMID: 22742913. DOI: 10.1016/j.jclinepi.2012.02.018.

17. Kazakov A.S., Lepakhin V.K., Astakhova A.V. Complications of pharmacotherapy associated with the interaction of drugs. Russkiy Mediko-biologicheskiy Vestnik = Russian Biomedical Journal 2013;3:70–6. (In Russ.).

18. Chernyaeva M.S., Ostroumova O.D., Sychev D.A. Druginduced orthostatic hypotension. Klinicheskaya pharmakologiya I pharmakoterapiya = Clinical pharmacology and therapy 2018;27(5): 57–63. (In Russ.)].

19. Sutherland J.J., Daly T.M., Liu X. et al. Co-prescription trends in a large cohort of subjects predict substantial drug-drug interactions. PLoS One 2015;10(3):e0118991. PMID: 25739022. DOI: 10.1371/journal.pone.0118991.