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Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study

Ekstam, Annika Kragh LU and Elmståhl, Sölve LU (2016) In Clinical Interventions in Aging 11. p.489-496
Abstract

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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Fall-risk-increasing drugs, Hip fracture, Mortality, Older people, Population based
in
Clinical Interventions in Aging
volume
11
pages
8 pages
publisher
Dove Medical Press Ltd.
external identifiers
  • Scopus:84966862627
ISSN
1176-9092
DOI
10.2147/CIA.S101832
language
English
LU publication?
yes
id
6483f953-c15d-42da-851c-32f05d32de51
date added to LUP
2016-06-01 15:02:38
date last changed
2016-09-20 03:09:58
@misc{6483f953-c15d-42da-851c-32f05d32de51,
  abstract     = {<p>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.</p>},
  author       = {Ekstam, Annika Kragh and Elmståhl, Sölve},
  issn         = {1176-9092},
  keyword      = {Fall-risk-increasing drugs,Hip fracture,Mortality,Older people,Population based},
  language     = {eng},
  pages        = {489--496},
  publisher    = {ARRAY(0x98cf0f8)},
  series       = {Clinical Interventions in Aging},
  title        = {Do fall-risk-increasing drugs have an impact on mortality in older hip fracture patients? A population-based cohort study},
  url          = {http://dx.doi.org/10.2147/CIA.S101832},
  volume       = {11},
  year         = {2016},
}