노인환자의 낙상 위험 약물 사용 현황과 낙상 발생 위험도 분석

Abstract

Central nervous system drugs, antihypertensives can cause drowsiness, confusion resulting in a fall. Taking these medicines further increases the risk of falls in elderly patients who have high risk of falls and take many kinds of drugs. A lot of researches on risk factors about a fall have been performed, but disturbance variables are often distorted the results. In this study, using case-crossover design to control other factors, we investigated the impact of drugs causing a fall to hospitalized elderly patients. We selected patients over 65 years of age who were reported about fall accidents between January 2009 and September 2011. Age, sex, fall risk assessment score, and underlying diseases were investigated. To analyze the risk of drug inducing fall, we researched the inpatients’exposure of medication within 7 days before having fall (risk period) and 1 month before the fall (period in contrast). Selected drugs inducing fall have already been noted as risk factors for a fall in literatures; Antihypertensive drugs, anticonvulsants,alzheimer's disease therapeutics, antiparkinsonian agents, antidepressants, antipsychotics, anxiolytics, sedatives, hypnotics and opioid analgesics, antihistamines, skeletal muscle relaxants and others such as metoclopramide. We found the elderly patients who have experience taking the medicine inducing a fall are 162 (96.4%), accounted for the majority. Patients taken four or more fall risk drugs in risk period were 71 cases (42.3%), compared to 26 cases (15.5%) in the contrasting period, which means the more fall risk drugs were taken during 7 days before having fall(p<0.001). Exposure medications such as diuretics (OR=2.3, 95% CI=1.3-4.2), antipsychotics (OR=2.8, 95% CI=1.2-6.4), zolpidem (OR=3.5, 95% CI=1.4-8.9), opioid analgesics (OR=3.5,95% CI=2.1-5.6) were significantly more likely to have falls during hospitalization. As mentioned above, the majority of elderly patients experienced a fall were exposed to fall risk drugs and took multi-drugs of them more than four. Therefore, it is needed to prepare the role of mediator as a pharmacist for preventing falls in elderly patients.