Welcome to visit Zhongnan Medical Journal Press Series journal website!

Home Articles Vol 32,2023 No.9 Detail

Influence of drug factors on falls in elderly patients with chronic diseases in the communities of Wuhan Qingshan district and research on prediction model

Published on Sep. 28, 2023Total Views: 1429 times Total Downloads: 416 times Download Mobile

Author: Jun-Ling WANG 1, 2 Qi ZHANG 2 Ling MA 2 Qiao-Yuan YAN 3 Jiao YE 2

Affiliation: 1. College of Medicine, Wuhan University of Science and Technology, Wuhan 430081, China 2. Department of Nursing, China Resources WISCO General Hospital of Wuhan University of Science and Technology, Wuhan 430080, China 3. Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China

Keywords: Chronic diseases Drugs Fall Elderly patients Community nursing Predictive model Nomogram

DOI: 10.19960/j.issn.1005-0698.202309006

Reference: Jun-Ling WANG, Qi ZHANG, Ling MA, Qiao-Yuan YAN, Jiao YE.Influence of drug factors on falls in elderly patients with chronic diseases in the communities of Wuhan Qingshan district and research on prediction model[J].Yaowu Liuxingbingxue Zazhi,2023,32(9):997-1007.DOI: 10.19960/j.issn.1005-0698.202309006.[Article in Chinese]

  • Abstract
  • Full-text
  • References
Abstract

Objective  To analyze the influence of drug factors on falls in the elderly patients with chronic diseases in the communities of Wuhan Qingshan district, and to construct a prediction model.

Methods  The elderly with chronic diseases in four communities of Wuhan Qingshan district were selected as the subjects by cluster random sampling method, the information on patients' age, gender, medication, and occurrence of falls of the patients were collected, and the fall-related drug risk factors were analyzed by multivariate Logistic regression model, the fall risk line chart prediction model was established, and the effectiveness of the model was verified by Bootstrap method.

Results  Among the 608 elderly patients with chronic diseases, 152 (25%) experienced falls after administration. The results of multivariate Logistic regression analysis showed that females (OR=1.835, 95%CI 1.228 to 2.742, P=0.003), using hypoglycemic drugs (OR=2.721, 95%CI 1.727 to 4.286, P<0.001), using sedative-hypnotic drugs (OR=1.948, 95%CI 1.220 to 3.111, P=0.005), using antihypertensive drugs (OR=1.779, 95%CI 1.119 to 2.829, P=0.015), taking two or more drugs (OR=2.251, 95%CI 1.309 to 3.869, P=0.003), and poor medication compliance (OR=3.048, 95%CI 1.926 to 4.824, P<0.001) were risk factors for falls after medication. Based on the above influencing factors, a nomogram model was established to predict falls in elderly patients; the verification results showed that the classification calibration curves fit closely, and the area under the ROC curve was 0.720 0 (95%CI 0.669 5 to 0.770 6, P<0.05).

Conclusion  The incidence of falls among the elderly with chronic diseases in the community is high in Qingshan district of Wuhan, and community medical staff and their families should pay attention to them. The prediction model has good predictive value, which is benefit to adopt targeted intervention measures to prevent and reduce the occurrence of falls in elderly patients with chronic diseases in the community.

Full-text
Please download the PDF version to read the full text: download
References

1.Shaver AL, Clark CM, Hejna M, et al. Trends infall-related mortality and fall risk increasing drugs among older individuals in the United States, 1999-2017[J]. Pharmacoepidemiol Drug Saf, 2021, 30(8): 1049-1056. DOI: 10.1002/pds.5201.

2.Goh JW, Singh D, Mesbah N, et al. Fall awareness behaviour and its associated factors among community dwelling older adults[J]. BMC Geriatr, 2021, 21(1): 226. DOI: 10.1186/s12877-021-02122-z.

3.蔡伦, 林岑, 周鼒, 等. 老年人跌倒的公共卫生研究进展[J]. 中国老年学杂志, 2018, 38(9): 2265-2268. [Cai L, Lin C, Zhou Z, et al. Progress in public health research on falls in the elderly[J]. Chinese Journal of Gerontology, 2018, 38(9): 2265-2268.] DOI: 10.3969/j.issn.1005-9202.2018.09.085.

4.Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature[J]. Maturitas, 2013,75(1):51-61. DOI: 10.1016/j.maturitas.2013.02.009.

5.胡惠菊, 韩静, 唐启群, 等. 养老机构老年人预防跌倒自我管理的现状及其影响因素研究[J]. 护理研究, 2021, 35(22): 4057-4062. [Hu HJ, Han J, Tang QQ, et al. Research on status quo of self-management abilities for fall prevention in elderly in elderly care institutions and its influencing factors[J]. Chinese Nursing Researsh, 2021, 35(22): 4057-4062.] DOI: 10.12102/j.issn.1009-6493.2021.22.021.

6.Kim K, Jung H, Kim CO, et al. Evidence-based guidelines for fall prevention in Korea[J]. Korean J Intern Med, 2017, 32(1): 199-210. DOI: 10.3904/kjim.2016.218.

7.高永祥, 张晋昕. Logistic回归分析的样本量确定[J].

循证医学, 2018, 18(2): 122-124. [Gao YX, Zhang JX. Determination of sample size in Logistic regression analysis[J]. The Journal of Evidence-Based Medicine, 2018, 18(2): 122-124.] DOI: 10.12019/j.issn.1671-5144. 2018.02.015.

8.顾晗昕, 刘洋, 刘远立. 政策工具视角下社区老年人跌倒干预国际比较研究[J]. 中国全科医学, 2023, 26(34): 4231-4238, 4245. [Gu HX, Liu Y, Liu YL. Falls prevention intervention for community-dwelling older adults from the perspective of policy tools:an international comparative study[J]. Chinese General Practice, 2023, 26(34): 4231-4238, 4245.] DOI: 10.12114/j.issn.1007-9572.2023.0092.

9.You L, Deans C, Liu K, et al. Raising awareness of fall risk among Chinese older adults. Use of the Home Fall Hazards Assessment tool[J]. J Gerontol Nurs, 2004, 30(6): 35-42. DOI: 10.3928/0098-9134-20040601-08.

10.陈瑞玲. 跌倒的药源性因素及干预策略[J]. 药品评价, 2019, 16(6): 13-15. [Chen RL. Drug-induced factors of falls and intervention strategies[J]. Pharmaceutical Administration, 2019, 16(6): 13-15, 58.] DOI: 10.3969/j.issn.1672-2809.2019.06.003.

11.翁艳君, 赵豫梅, 刘伟军, 等. 中文版8条目Morisky服药依从性量表在2型糖尿病患者中的信效度评价及应用研究[J]. 中华临床医师杂志(电子版), 2018, 12(8): 445-450. [Weng YJ, Zhao YM, Liu WJ, et al. Reliability and validity of Chinese version of 8-item Morisky medication adherence scale in patients with type 2 diabetes[J]. Chin J Clinicians (Elect-ronic Edition), 2018, 12(8): 445-450.] DOI: 10.3877/cma.j.issn.1674-0785.2018.08.004.

12.Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living[J]. Gerontologist, 1969, 9(3): 179-186. https://pubmed.ncbi.nlm.nih.gov/5349366/.

13.Morse JM, Black C, Oberle K, et al. A prospective study to identify the fall-prone patient[J]. Soc Sci Med, 1989, 28(1): 81-86. DOI: 10.1016/0277-9536(89)90309-2.

14.Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical  tool for identification of nutritional status[J]. J Nutr Health Aging, 2009, 13(9): 782-788. DOI: 10.1007/s12603-009-0214-7.

15.赵玉兰, 皮远萍, 唐玲, 等. 精细化管理在肿瘤住院患者跌倒风险管理中的应用[J]. 检验医学与临床, 2017, 14(14): 2121-2124. [Zhao YL, Pi YP, Tang L, et al. The application of refined management by the People's Health Publishing House in the risk management of falls in cancer inpatients[J]. Laboratory Medicine and Clinic, 2017, 14(14): 2121-2124.] DOI: 10.3969/j.issn.1672-9455.2017.14.044.

16.梁运银, 谭秋浓, 甘小燕. 社区综合干预对预防老年慢性病患者跌倒的影响[J]. 齐鲁护理杂志, 2019, 25(9): 78-80. [Liang YY, Tan QN. Effect of comprehensive community intervention on preventing falls in elderly patients with chronic diseases[J]. Journal of Qilu Nursing, 2019, 25(9): 78-80.] DOI: 10.3969/j.issn.1006-7256.2019.09.027.

17.Valderrama-Hinds LM, Al SS, Chen NW, et al. Falls in Mexican older adults aged 60 years and older[J]. Aging Clin Exp Res, 2018, 30(11): 1345-1351. DOI: 10.1007/s40520-018-0950-9.

18.Franse CB, Rietjens JA, Burdorf A, et al. A prospective study on the variation in falling and fall risk among community-dwelling older citizens in 12 European countries[J]. BMJ Open, 2017, 7(6): e15827. DOI: 10.1136/bmjopen-2017-015827.

19.Smith AA, Silva AO, Rodrigues RA, et al. Assessment of risk of falls in elderly living at home[J]. Rev Lat Am Enfermagem, 2017, 25: e2754. DOI: 10.1590/1518-8345.0671.2754

20.王倩倩, 张砚卓, 吴成爱. 中国中老年人群中跌倒的危险因素分析: 基于中国健康与养老追踪调查(CHARLS)数据[J]. 中国老年学杂志, 2019, 39(15): 3794-3799. [Wang QQ, Zhang YZ, Wu CA. Risk factors for falls in middle-aged and elderly populations in China: based on data from the China Health and Elderly Care Longitudinal Survey (CHARLS)[J]. Chinese Journal of Gerontology, 2019, 39(15): 3794-3799.] DOI: 10.3969/j.issn.1005-9202.2019.15.061.

21.齐伯嫣, 常翰玉, 刘丹, 等. 大连市社区老年人跌倒发生及其影响因素[J]. 中国老年学杂志, 2021, 41(13): 2866-2869. [Qi BY, Chang HY, Liu D, et al. Incidence and influencing factors of falls among elderly people in Dalian community[J]. Chinese Journal of Gerontology, 2021, 41(13): 2866-2869.] DOI: 10.3969/j.issn.1005-9202.2021.13.051.

22.Barron RL, Oster G, Grauer A, et al. Determinants of imminent fracture risk in post-menopausal women with osteoporosis[J]. Osteoporos Int, 2020, 31(11): 2103-2111. DOI: 10.1007/s00198-020-05294-3.

23.He J, Xu S, Zhang B, et al. Gut microbiota and metabolite alterations associated with reduced bone mineral density or bone metabolic indexes in postmenopausal osteoporosis[J]. Aging (Albany NY), 2020, 12(9): 8583-8604. DOI: 10.18632/aging.103168.

24.Zeng Q, Li N, Wang Q, et al. The Prevalence of Osteoporosis in China, a Nationwide, Multicenter DXA Survey[J]. Journal of Bone and Mineral Research, 2019, 34(10): 1789-1797. DOI: 10.1002/jbmr.3757.

25.Janakiraman B, Temesgen MH, Jember G, et al. Falls among community-dwelling older adults in Ethiopia; A preliminary cross-sectional study[J]. PLoS One, 2019, 14(9): e221875. DOI: 10.1371/journal.pone.0221875.

26.Tsai Y, Yang P, Yang Y, et al. Prevalence and risk factors of falls among community-dwelling older people: results from three consecutive waves of the national health i-nterview survey in Taiwan[J]. BMC Geriatrics, 2020, 20(1): 529. DOI: 10.1186/s12877-020-01922-z.

27.Rasmussen NH, Dal J, den Bergh JV, et al. Increased risk of falls, fall-related injuries and fractures in people with type 1 and type 2 diabetes - a nationwide cohort study[J]. Curr Drug Saf, 2021, 16(1): 52-61. DOI: 10.2174/1574886315666200908110058.

28.高乐, 李志霞, 杨俊, 等. 胰高血糖素样肽1受体激动剂类降糖药致2型糖尿病患者头疼和眩晕的网状Meta分析[J]. 药物流行病学杂志, 2018, 27(1): 3-9. [Gao L, Li ZX, Yang J, et al. Impact of glucagon-like peptide-1 receptor agonists on headache and dizziness a-mong type 2 diabetes: a network meta-analysis[J]. Chinese Journal of Pharmacoepide-miology, 2018, 27(1): 3-9.] DOI: 10.19960/j.cnki.issn1005-0698.2018.01.002.

29.于普林. 北京市社区老年人跌倒状况研究[D]. 长沙: 中南大学, 2010.

30.侯蔚蔚, 孙爱芳, 万岐江. 老年患者住院期间跌倒风险及相关因素分析[J]. 中国医药导刊, 2019, 21(11): 660-664. [Hou WW, Sun AF, Wan QJ, Analysis of the fall risk and related factors in hospitalized elderly patients[J].Chinese Journal of Medicinal Guide, 2019, 21(11): 660-664.] DOI: 10.3969/j.issn.1009-0959.2019.11.006.

31.范丽凤, 郑亚光, 朱秀勤, 等. 糖尿病患者跌倒及其危险因素研究[J]. 中华护理杂志, 2004, 39(10): 730-734. [Fan LF, Zheng YG, Zhu XQ, et al. Study on falls and its risks factors in patients with diabetes[J]. Chinese Journal of Nursing, 2004, 39(10): 730-734.] DOI: CNKI:SUN:ZHHL.0.2004-10-004.

32.蔺建宇, 张英, 孙超, 等. 镇静催眠药物致老年患者住院期间跌倒的原因分析及对策[J]. 中华老年医学杂志, 2017, 36(6): 627-631. [Lin JY, Zhang Y, Sun C, et al. Analysis of the causes of fall as an adverse event in elderly patients taking sedative or hypnotic drugs and the countermeasures[J]. Chinese Journal of Geriatrics, 2017, 36(6): 627-631.] DOI: 10.3760/cma.j.issn.0254-9026. 2017.06.006.

33.Torii H, Ando M, Tomita H, et al. Association of hypnotic drug use with fall incidents in hospitalized elderly patients: a case-crossover study[J]. Biol Pharm Bull, 2020, 43(6): 925-931. DOI: 10.1248/bpb.b19-00684.

34.Avin KG, Hanke TA, Kirk-Sanchez N, et al. Management of falls in community-dwelling older adults: clinical guidance statement from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association[J]. Phys Ther, 2015, 95(6): 815-834. DOI: 10.2522/ptj.20140415.

35.Osman A, Kamkar N, Speechley M, et al. Fall risk-increasing drugs and gait performance in community-dwelling older adults: a systematic review[J]. Ageing Res Rev, 2022, 77: 101599. DOI: 10.1016/j.arr.2022.101599.

36.刘久红, 郭琪. 长期服用镇静催眠药产生依赖性23例[J]. 中国药师, 2005, 8(6): 520. [Liu JH, Guo Q. 23 cases of dependence caused by long term taking sedative and hypnotic drugs[J]. China PharmaCist, 2005, 8(6): 520.] DOI: 10.3877/cma.j.issn.1674-0785.2018.08.004.

37.Berry SD, Kiel DP. Treating hypertension in the elderly: should the risk of falls be part of the equation?[J]. JAMA Intern Med, 2014, 174(4): 596-597. DOI: 10.1016/j.arr.2022.101599.

38.Pit SW, Byles JE, Henry DA, et al. A quality use of medicines program for general practitioners and older people: a cluster randomised controlled trial[J]. Med J Aust, 2007, 187(1): 23-30. DOI: 10.5694/j.1326-5377.2007.tb01110.x.

39.Zia A, Kamaruzzaman SB, Tan MP. The consumption of two or more fall risk-incr-easing drugs rather than polypharmacy is associated with falls[J]. Geriatr Gerontol Int, 2017, 17(3): 463-470. DOI: 10.1111/ggi.12741.

40.张亚同, 车宁, 邱蕾. 中国老年人用药管理评估技术应用共识(草案)[J]. 中国老年保健医学, 2019, 17(4): 16-19. [Zhang YT, Che N, Qiu L. Consensus on the application of medi-cation management evaluation technology for the elderly in China (draft)[J]. Chinese Geriatric Health Medicine, 2019, 17(4): 16-19.] DOI: 10.3969/j.issn.1672-2671.2019.04.004.

41.Dillon P, Smith SM, Gallagher PJ, et al. Association between gaps in antihypertens-ive medication adherence and injurious falls in older community-dwelling adults: a prospective cohort study[J]. BMJ Open, 2019, 9(3): e22927. DOI: 10.1136/bmjopen-2018-022927.

42.王鹏, 边萌, 王青, 等. 老年患者潜在不适当用药与跌倒的相关性[J]. 中华老年多器官疾病杂志, 2019, 18(2): 117-121. [Wang P, Bian M, Wang Q, et al. Association of potentially inappropriate medications with falls in elderly patients[J]. Chinese Journal of Multiple Organ Diseases in the Elderly, 2019, 18(2): 117-121.] DOI: 10.11915/j.issn.1671-5403.2019.02.022.

43.Hagger MS, Hardcastle SJ, Hu M, et al. Effects of medication, treatment, and behavioral beliefs on intentions to take medication in patients with familial hypercholesterolemia[J]. Atherosclerosis, 2018, 277: 493-501. DOI: 10.1016/j.atherosclerosis.2018.06.010.

44.Chen L, Wen Y, Zhang J, et al. Prediction of radiotherapy response with a 5-microRNA signature-based nomogram in head and neck squamous cell carcinoma[J]. Cancer Med, 2018, 7(3): 726-735. DOI: 10.1002/cam4.1369.

Popular papers
Last 6 months