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Association between polypharmacy and falls in older adults: a longitudinal study from England
  1. Nafeesa N Dhalwani1,
  2. Radia Fahami1,
  3. Harini Sathanapally1,
  4. Sam Seidu1,
  5. Melanie J Davies1,2,
  6. Kamlesh Khunti1
  1. 1Department of Diabetes Research Centre, University of Leicester, Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
  2. 2Leicester Biomedical Research Centre, Leicester, UK
  1. Correspondence to Dr Nafeesa N Dhalwani; nnd2{at}le.ac.uk

Abstract

Objectives Assess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.

Design Longitudinal cohort study.

Setting The English Longitudinal Study of Ageing waves 6 and 7.

Participants 5213 adults aged 60 or older.

Main outcome measures Rates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.

Results A total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9–2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67).

Conclusions We found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.

  • clinical pharmacology
  • epidemiology
  • geriatric medicine
  • primary care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors ND conceived and designed the study, acquired the data, carried out statistical analyses, interpreted the results and drafted the manuscript. RF interpreted the results and drafted and revised parts of the manuscript. HS acquired and managed the data and reviewed the manuscript for critical revisions. SS reviewed the manuscript for critical revisions. MJD reviewed the manuscript for critical revisions. KK conceived the idea of the study, designed the study, provided input in the interpretation of findings and reviewed the manuscript. All authors have approved the final manuscript as submitted.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KK has acted as a consultant and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. KK has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. MJD has acted as consultant, advisory board member and speaker for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca and Janssen, and as a speaker for Mitsubishi Tanabe Pharma Corporation. She has received grants in support of investigator and investigator-initiated trials from Novo Nordisk, Sanofi-Aventis and Lilly.

  • Patient consent The study uses secondary data from ELSA available publicly. All participants gave full informed written consent for participation in the study

  • Ethics approval Ethical approval for ELSA was obtained from NHS Research Ethics Committees under the National Research and Ethics Service (NRES), and participants gave full informed written consent for participation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available. However, ELSA can be freely accessed through the UK Data Archive.

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