Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Aleksandra A. Zecevic

Abstract

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one year before they had fall-related injuries. Study 2 and 3 were case-control studies. The cases were older adults aged 66 years and older, who had a fall-related injury between January 2010 and December 2014. Controls were older adults with same age, sex and residence area as the cases. In study 2, medications prescribed to both groups were recorded and logistic regression was conducted to examine the association between medications and injuries. Study 3 defined continuous use as medication use for more than 90 days and new initiation was defined as starting a medication within 30 days prior to injuries. Logistic regression was conducted to examine the association between injuries and continuous use or new initiation of medications.

Results: Within one year before the injury, 27.2% of older adults were prescribed antidepressants, 25.0% opioids, 16.6% anxiolytics, and 36.4% were prescribed 5-9 medications and 41.2% were prescribed 10 or more medications. After adjustment for sex, age group, residence area, income and number of medications prescribed, laxatives, antibiotics and bronchodilators were identified to increase the risk of fall-related injury. Continuous use of antidepressants, anticholinesterases and antithrombin agents and new initiation of antidepressants, opioids and cephalosporins were reported to increase the risk for injuries.

Conclusion: Findings of this thesis uncovered several medication classes such as antibiotics and bronchodilators were associated with increased risk of fall-related injury. Both, continuous use and new initiation of particular medication classes were associated with injuries. Well-designed prospective cohort studies are needed to provide more convincing evidence.

Summary for Lay Audience

Fall-related injuries in older adults can result in serious harm to individuals and health care system, especially with the world increasing aging population. The purpose of this study was to (1) describe the types of medications older adults used within one year before they experienced a fall that resulted in an injury; (2) identify if medications prescribed within 30 days before the fall that were associated with increased the risk of fall-related injury; and (3) find out whether continuous use of a medication or start of a new medication were associated with increased the risk of fall-related injury. Data was extracted from databases hosted by IC/ES. We recorded the medication prescribed to older adults and calculate the percentage of medication users. Our result was, within one year before the injury, 27.2% of older adults used antidepressants, 25.0% opioids, 16.6% anxiolytics, 36.4% used 5-9 different medications and 41.2% used 10 or more different medications. Then we used case-control study design and logistic regression to find out the possibility of having fall-related injury when an older adult took certain kind of medication. We also identified the possibility of having fall-related injuries when an older adult took certain kind of medication for over 90 days or start a new medication within 30 days prior to the injury. After taking sex, age group, residence area, income level and number of medications used into consideration, we found that users of laxatives, antibiotics and inhaled medications for asthma were more likely to have fall-related injury. Continuous use of antidepressants, medications for dementia and blood thinners and new initiation of antidepressants, opioids and cephalosporins were associated with increased risk for fall-related injuries. Findings of this thesis uncovered several medication classes such as antibiotics and bronchodilators that were associated with increased risk of fall-related injury, which was not reported in previous studies. It was also suggested that continuous use and new initiation of particular medication classes were associated with injuries. Well-designed cohort studies are needed in the future to provide more convincing evidence.

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