Falls and Drugs in the Older Population: medical and societal consequences

Falls represent a major public health problem among older persons in western countries, since approximately a third of all persons aged 65 years and older experience at least one fall per year. This thesis provides insights in the epidemiology, injury patterns, healthcare costs, and mortality rates of falls in older adults. Furthermore, drug knowledge in older adults, hospitalizations due to an adverse drug reaction, and withdrawal of fall-risk increasing drugs as a preventative measure will be discussed. The main findings include that falls are leading to a high healthcare consumption. Per year, approximately 72.000 elderly visit the Emergency Department with injuries due to a fall (The Netherlands, 2007-2009). Fall-related injuries are age- and gender dependent. Women and the oldest old (>80 years) present more often with fractures, and have a higher injury severity. Over the last 28-years the number of admissions increased rapidly (1981, 14.000; 2008, 34.000). The increase was also seen in the United States. Main injury categories requiring admission were hip fractures, superficial injuries, and head injuries. The total number of required hospital bed days remained stable due a reduction of over 50% in the length of hospital stay per admission. Also fall-related mortality was reduced (1969-2008), and mortality rates for men and women became comparable. Pharmacotherapy is commonly used to treat medical conditions, but it is well known that side effects increase with an increasing number of drugs. Side effects include among others an increased fall-risk. Especially older adults are at risk for Adverse Drug Reactions, due to poor drug knowledge and polypharmacy, as shown in our data. The epidemiology of Adverse Drug Reactions related admissions is shown (The Netherlands, 1981-2007). A measure which might be useful to reduce the number of falls, is the reduction of fall-risk increasing drug, if possible. Therefore the protocol of a randomized controlled trial (IMPROveFALL study) is presented. The study results will be expected in 2013.

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