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Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study
OBJECTIVE: The aim of this study was to assess the mortality in hip fracture patients with regard to use of fall-risk-increasing drugs (FRIDs), by comparing survival in exposed and nonexposed individuals. DESIGN: This was a general population-based cohort study. SETTINGS: Data on hip fracture patien...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857759/ https://www.ncbi.nlm.nih.gov/pubmed/27199553 http://dx.doi.org/10.2147/CIA.S101832 |
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author | Kragh Ekstam, Annika Elmståhl, Sölve |
author_facet | Kragh Ekstam, Annika Elmståhl, Sölve |
author_sort | Kragh Ekstam, Annika |
collection | PubMed |
description | OBJECTIVE: The aim of this study was to assess the mortality in hip fracture patients with regard to use of fall-risk-increasing drugs (FRIDs), by comparing survival in exposed and nonexposed individuals. DESIGN: This was a general population-based cohort study. SETTINGS: Data on hip fracture patients were retrieved from three national databases. PARTICIPANTS: All hip fracture patients aged 60 years or older in a Swedish county in 2006 participated in this study. MEASUREMENTS: We studied the mortality in hip fracture patients by comparing those exposed to FRIDs, combinations of FRIDs, and polypharmacy to nonexposed patients, adjusting for age and sex. For survival estimates in patients using four or more FRIDs, a Cox regression analysis was used, adjusting for age, sex, and use of any four or more drugs. RESULTS: First-year all-cause mortality was 24.6% (N=503) in 2,043 hip fracture patients aged 60 years or older, including 170 males (33.8%) and 333 females (66.2%). Patients prescribed four or more FRIDs, five or more drugs (polypharmacy), psychotropic drugs, and cardiovascular drugs showed significantly increased first-year mortality. Exposure to four or more FRIDs (518 patients, 25.4%) was associated with an increased mortality at 30 days with odds ratios (ORs) 2.01 (95% confidence interval [CI] 1.44–2.79), 90 days with OR 1.56 (95% CI 1.19–2.04), 180 days with OR 1.54 (95% CI 1.20–1.97), and 365 days with OR 1.43 (95% CI 1.13–1.80). Cox regression analyses adjusted for age, sex, and use of any four or more drugs showed a significantly higher mortality in patients treated with four or more FRIDs at 90 days (P=0.015) and 180 days (P=0.012) compared to patients treated with three or less FRIDs. CONCLUSION: First-year all-cause mortality was significantly higher in older hip fracture patients exposed before the fracture to FRIDs, in particular to four or more FRIDs, polypharmacy, psychotropic, and cardiovascular drugs. Interventions aiming to optimize both safety and benefit of drug treatment for older people should include limiting the use of FRIDs. |
format | Online Article Text |
id | pubmed-4857759 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-48577592016-05-19 Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study Kragh Ekstam, Annika Elmståhl, Sölve Clin Interv Aging Original Research OBJECTIVE: The aim of this study was to assess the mortality in hip fracture patients with regard to use of fall-risk-increasing drugs (FRIDs), by comparing survival in exposed and nonexposed individuals. DESIGN: This was a general population-based cohort study. SETTINGS: Data on hip fracture patients were retrieved from three national databases. PARTICIPANTS: All hip fracture patients aged 60 years or older in a Swedish county in 2006 participated in this study. MEASUREMENTS: We studied the mortality in hip fracture patients by comparing those exposed to FRIDs, combinations of FRIDs, and polypharmacy to nonexposed patients, adjusting for age and sex. For survival estimates in patients using four or more FRIDs, a Cox regression analysis was used, adjusting for age, sex, and use of any four or more drugs. RESULTS: First-year all-cause mortality was 24.6% (N=503) in 2,043 hip fracture patients aged 60 years or older, including 170 males (33.8%) and 333 females (66.2%). Patients prescribed four or more FRIDs, five or more drugs (polypharmacy), psychotropic drugs, and cardiovascular drugs showed significantly increased first-year mortality. Exposure to four or more FRIDs (518 patients, 25.4%) was associated with an increased mortality at 30 days with odds ratios (ORs) 2.01 (95% confidence interval [CI] 1.44–2.79), 90 days with OR 1.56 (95% CI 1.19–2.04), 180 days with OR 1.54 (95% CI 1.20–1.97), and 365 days with OR 1.43 (95% CI 1.13–1.80). Cox regression analyses adjusted for age, sex, and use of any four or more drugs showed a significantly higher mortality in patients treated with four or more FRIDs at 90 days (P=0.015) and 180 days (P=0.012) compared to patients treated with three or less FRIDs. CONCLUSION: First-year all-cause mortality was significantly higher in older hip fracture patients exposed before the fracture to FRIDs, in particular to four or more FRIDs, polypharmacy, psychotropic, and cardiovascular drugs. Interventions aiming to optimize both safety and benefit of drug treatment for older people should include limiting the use of FRIDs. Dove Medical Press 2016-04-29 /pmc/articles/PMC4857759/ /pubmed/27199553 http://dx.doi.org/10.2147/CIA.S101832 Text en © 2016 Kragh Ekstam and Elmståhl. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Kragh Ekstam, Annika Elmståhl, Sölve Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study |
title | Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study |
title_full | Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study |
title_fullStr | Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study |
title_full_unstemmed | Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study |
title_short | Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study |
title_sort | do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? a population-based cohort study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857759/ https://www.ncbi.nlm.nih.gov/pubmed/27199553 http://dx.doi.org/10.2147/CIA.S101832 |
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