Patterns of fall-risk increasing drugs (FRIDs) use and associations with falls in residential aged care: A group-based multi-trajectory analysis of an 8-year longitudinal cohort study

Tuesday, August 27, 2024

9:00 AM – 9:15 AM CEST

Location: Room II

Presenting Author(s)

Nasir Wabe

Senior Research Fellow
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia

Slides

Co-Author(s)

GH

Guogui Huang

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
SS

Sandun Silva

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
AN

Amy Nguyen

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University AND St Vincent’s Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, Australia, Australia
KS

Karla Seaman

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
Magdalena Z. Raban, BPharm, MIPH, PhD (she/her/hers)

Associate Professor
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
PG

Peter Gates

National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia, Australia
RD

Richard Day

St Vincent’s Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, Australia, Australia
JC

Jacqueline Close

Neuroscience Research Australia, UNSW Sydney, Sydney, Australia AND School of Clinical Medicine, UNSW Sydney, Sydney, Australia, Australia
SL

Stephen Lord

Neuroscience Research Australia, UNSW Sydney, Sydney, Australia AND School of Population Health, UNSW Sydney, Sydney, Australia, Australia
JW

Johanna Westbrook

Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia

Background: Falls are prevalent in residential aged care (RAC) homes. Fall-risk increasing drugs (FRIDs), including psychotropics and cardiovascular disease (CVD) drugs, are widely believed to increase the risk of falls due to their pharmacological mechanisms. Nevertheless, epidemiological studies report mixed results. Studies in RAC settings are scarce, with existing studies constrained by design limitations.

Objectives: To identify concurrent trajectories of the use of two FRID classes over time and determine their associations with falls in RAC homes.

Methods: Study design: A longitudinal cohort study using electronic health data from 4,207 newly admitted permanent residents.
Settings: 27 RAC homes in Sydney, New South Wales, Australia.
Exposures: Psychotropics and CVD FRIDs use. We measured exposure to each FRID class over 60 months using the Proportion of Days Covered (PDC) metric.
Outcome measures: Incidence of all and injurious falls.
Statistical analysis: We used group-based multi-trajectory modelling to determine concurrent trajectories of the use of psychotropics and CVD FRIDs and negative binomial regression to assess their associations with the outcomes.

Results: Of 4,207 residents, 63.6% (n=2,677) were female and the median age was 87 years. A total of 83.6% (n=3,516) and 77.3% (n=3,254) of residents used psychotropic and CVD FRIDs respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α adrenoceptor antagonists) to 89.6% (β blockers) for CVD FRIDs. The model identified four trajectory groups: Residents in Group 1 (low psychotropics-low CVDs use, 16.7%, n=701); Group 2 (low psychotropics-high CVDs, 25.0%, n=1054); Group 3 (high psychotropics-high CVDs, 41.0%, n=1723); Group 4 (high psychotropics-low CVDs, 17.3%, n=729). Group 4 had a significantly higher rate of falls (and injurious falls) than the other groups, including relative to Group 3, in which exposure to both FRID classes was high. For example, Group 4 had a 26% (IRR 1.26; 95% CI 1.11-1.43) increased rate of all falls compared to Group 3.

Conclusions: Our findings highlight a high use of FRIDs in RAC homes, and a crucial distinction in the impact of psychotropics and CVD FRIDs on falls. Psychotropics show a strong association with falls, while CVD FRIDs do not. Opportunities exist to review the use of medications associated with potential harm in RAC homes.