Background
Methods
Patient data
Developing categorization of medicines increasing fall risk (FRIDs)
Frequency of ADEs | Number of patients experiencing ADEs | Fall risk level |
---|---|---|
Very common | ≥ 1/10 | A |
Common | ≥ 1/100 to < 1/10 | A |
Uncommon | ≥ 1/1000 to < 1/100 | B |
Rare | ≥ 1/10000 to < 1/1000 | C |
Very rare | < 1/10000 | C |
Frequency of use of high fall risk medicines in study participants with a fall history
Fall risk item | Responsible person | Confirmation | Points in the scale |
---|---|---|---|
Evidence of fall during a month prior the assessment | nurse | ✓ | 1 |
Confusion, lack of risk perception, restlessness | nurse | ✓ | 1 |
Impaired balance, gait disturbance | nurse | ✓ | 1 |
Occurrence of dizziness and drowsiness | nurse | ✓ | 1 |
Statistical analysis
Results
Study participants
Characteristics | Hospital | Nursing home | Total | |
---|---|---|---|---|
Sex n (%) | Male | 67 (52) | 18 (30) | 85 (45) |
Female | 61 (48) | 42 (70) | 103 (55) | |
Age, years, mean (range) | 80 (60–97) | 77 (63–95) | 79 (60–97) | |
MMSE, mean (range) | 21.7 (5–30) | unknown | – | |
Length of stay, days, mean (range) | 15.8 (1–56) | permanent | – | |
Number of drugs in use, mean (range) | 10.0 (3–17) | 7.8 (2–15) | 9.3 (2–17) |
The fall risk scores of study participants assessed on admission
Scores | Fall risk level | Number of patients | Proportion (%) of patients |
---|---|---|---|
0 | No risk | 5 | 3 |
1 | Low risk | 17 | 9 |
2 | Medium risk | 66 | 35 |
3 | High risk | 69 | 37 |
4 | Full risk | 31 | 16 |
Categorization of medicines according to their fall risk by applying SmPCs and frequency of use
Active ingredient (number of users) | Drug class (ATC) | Frequency of ADEs according to SmPCs |
---|---|---|
Metoprolol (n = 49) | Beta blocking agents (C07A) | Common: dizziness, bradycardia |
Perindopril (n = 38) | ACE inhibitors (C09A) | Common: dizziness, orthostatic hypotension, syncope |
Tiapride (n = 36) | Antipsychotics (N05A) | Common: dizziness, drowsiness |
Quetiapine (n = 24) | Antipsychotics (N05A) | Very common: dizziness, drowsiness Common: orthostatic hypotension |
Tramadol (n = 24) | Opioids (N02A) | Very common: dizziness Common: drowsiness |
Citalopram (n = 23) | Antidepressants (N06A) | Very common: drowsiness Common: dizziness |
Amlodipine (n = 23) | Calcium channel blockers (C08C) | Common: dizziness, drowsiness |
Melperon (n = 23) | Antipsychotics (N05A) | Very common: sedation Common: dizziness |
Bromazepam (n = 20) | Anxiolytics (N05B) | Common: drowsiness, fallsa |
Digoxin (n = 18) | Cardiac glycosides (C01A) | Common: bradycardia, dizziness |
Ramipril (n = 18) | ACE inhibitors (C09A) | Common: dizziness, orthostatic hypotension, syncope |
High fall risk (A) | ATC Code | ATC classification | Users of the medicines n (%) |
---|---|---|---|
Metoprolol | C07AB02 | Beta blocking agents | 49 (26.1) |
Perindopril | C09AA04 | ACE inhibitors | 38 (20.2) |
Tiapride | N05AL03 | Antipsychotics | 36 (19.1) |
Quetiapine | N05AH04 | Antipsychotics | 24 (12.8) |
Tramadol | N02AX02 | Opioids | 24 (12.8) |
Citalopram | N06AB04 | Antidepressants | 23 (12.2) |
Amlodipine | C08CA01 | Calcium channel blockers | 23 (12.2) |
Melperone | N05AD03 | Antipsychotics | 23 (12.2) |
Bromazepam | N05BA08 | Anxiolytics | 20 (10.6) |
Ramipril | C09AA04 | ACE inhibitors | 18 (9.6) |
Digoxin | C01AA05 | Cardiac glycosides | 18 (9.6) |
Tramadol combination | N02AJ13 | Opioids | 16 (8.5) |
Bisoprolol | C07AB07 | Beta blocking agents | 16 (8.5) |
Zolpidem | N05CF02 | Hypnotics and Sedatives | 15 (8.0) |
Donepezil | N06DA02 | Anti-dementia drugs | 14 (7.4) |
Mirtazapine | N06AX11 | Antidepressants | 14 (7.4) |
Amiodarone | C01BD01 | Antiarrhythmics | 14 (7.4) |
Oxazepam | N05BA04 | Anxiolytics | 14 (7.4) |
Tamsulosin | G04CA02 | Urologicals | 14 (7.4) |
Memantine | N06DX01 | Anti-dementia drugs | 12 (6.4) |
Diazepam | N05BA01 | Anxiolytics | 11 (5.9) |
Gabapentin | N03AX12 | Antiepileptics | 11 (5.9) |
Trazodone | N06AX05 | Antidepressants | 10 (5.3) |
Isosorbide mononitrate | C01DA14 | Vasodilatators | 10 (5.3) |
Clonazepam | N03AE01 | Antiepileptics | 10 (5.3) |
Codein combination | N02AJ06 | Opioids | 9 (4.8) |
Risperidone | N05AX08 | Antipsychotics | 8 (4.3) |
Losartan | C09CA01 | AT II receptor blockers | 8 (4.3) |
Sertraline | N06AB06 | Antidepressants | 7 (3.7) |
Levodopa | N04BA01 | Dopaminergic agents | 7 (3.7) |
Aminophylline | R03DA05 | Drugs for obstructive airway diseases | 7 (3.7) |
Carvedilol | C07AG02 | Beta blocking agents | 7 (3.7) |
Fentanyl | N02AB03 | Opioids | 6 (3.2) |
Rosuvastatin | C10AA07 | Lipid modifying agents | 6 (3.2) |
Betaxolol | C07AB05 | Beta blocking agents | 6 (3.2) |
Haloperidol | N05AD01 | Antipsychotics | 6 (3.2) |
Levomepromazine | N05AA02 | Antipsychotics | 6 (3.2) |
Pregabalin | N03AX16 | Antiepileptics | 6 (3.2) |
Nitrofurantoin | J01XE01 | Antibacterials for systemic use | 6 (3.2) |
Urapidil | C02CA06 | Antiadrenergic agents | 5 (2.7) |
Rilmenidine | C02AC06 | Antiadrenergic agents | 5 (2.7) |
Nebivolol | C07AB12 | Beta blocking agents | 5 (2.7) |
Escitalopram | N06AB10 | Antidepressants | 5 (2.7) |
Telmisartan | C09CA07 | AT II receptor blockers | 5 (2.7) |
Midazolam | N05CD08 | Hypnotics and Sedatives | 5 (2.7) |
Alprazolam | N05BA12 | Anxiolytics | 5 (2.7) |
Perindopril/Indapamide | C09BA04 | ACE inhibitors combination | 5 (2.7) |
Verapamil | C08DA01 | Calcium channel blockers | 4 (2.1) |
Amiloride/Hydrochlorthiazide | C03EA01 | Diuretics | 4 (2.1) |
Rivastigmine | N06DA03 | Anti-dementia drugs | 4 (2.1) |
Olanzapine | N05AH03 | Antipsychotics | 4 (2.1) |
Dutasteride/Tamsulosin | G04CA52 | Urologicals | 4 (2.1) |
Trimetazidine | C01EB15 | Other cardiac preparations | 4 (2.1) |
Fosinopril | C09AA09 | ACE inhibitors | 3 (1.6) |
Isosorbide dinitrate | C01DA08 | Vasodilatators | 3 (1.6) |
Aceclofenac | M01AB16 | Anti-inflammatory drugs | 3 (1.6) |
Captopril | C09AA01 | ACE inhibitors | 3 (1.6) |
Baclofen | M03BX01 | Muscle relaxants | 3 (1.6) |
Lansoprazole | A02BC03 | Drug for peptic ulcer and reflux | 3 (1.6) |
Cefuroxime | J01DC02 | Antibacterials for systemic use | 3 (1.6) |
Levetiracetam | N03AX14 | Antiepileptics | 2 (1.1) |
Propafenone | C01BC03 | Antiarrhythmics | 2 (1.1) |
Carbamazepine | N03AF01 | Antiepileptics | 2 (1.1) |
Diclofenac | M01AB05 | Anti-inflammatory drugs | 2 (1.1) |
Solifenacin/Tamsulosin | G04CA53 | Urologicals | 2 (1.1) |
Oxycodone | N02AA05 | Opioids | 2 (1.1) |
Trandolapril | C09AA10 | ACE inhibitors | 2 (1.1) |
Levodopa/Carbidopa | N04BA02 | Dopaminergic agents | 2 (1.1) |
Perindopril/Amlodipine/Indapamide | C09BX01 | ACE inhibitors combination | 2 (1.1) |
Bicalutamide | L02BB03 | Hormone antagonists | 2 (1.1) |
Glyceryl trinitrate | C01DA02 | Vasodilatators | 2 (1.1) |
Fluoxetine | N06AB03 | Antidepressants | 1 (0.5) |
Dosulepin | N06AA16 | Antidepressants | 1 (0.5) |
Mianserin | N06AX03 | Antidepressants | 1 (0.5) |
Candesartan | C09CA06 | AT II receptor blockers | 1 (0.5) |
Venlafaxine | N06AX16 | Antidepressants | 1 (0.5) |
Telmisartan/Hydrochlorothiazide | C09DA07 | AT II receptor blockers combination | 1 (0.5) |
Tizanidine | M03BX02 | Muscle relaxants | 1 (0.5) |
Lisinopril | C09AA03 | ACE inhibitors | 1 (0.5) |
Famotidine | A02BA03 | Drug for peptic ulcer and reflux | 1 (0.5) |
Quinapril/Hydrochlorothiazide | C09BA06 | ACE inhibitors combination | 1 (0.5) |
Naftidrofuryl | C04AX21 | Peripheral vasodilatators | 1 (0.5) |
Celiprolol | C07AB08 | Beta blocking agents | 1 (0.5) |
Paroxetine | N06AB05 | Antidepressants | 1 (0.5) |
Methyldopa | C02AB01 | Antiadrenergic agents | 1 (0.5) |
Tianeptine | N06AX14 | Antidepressants | 1 (0.5) |
Doxazosin | C02CA04 | Antiadrenergic agents | 1 (0.5) |
Ticagrelor | B01AC24 | Antithrombotic agents | 1 (0.5) |
Losartan/Hydrochlorothiazide | C09DA01 | ACE inhibitors combination | 1 (0.5) |
Codeine | R05DA04 | Cough suppressants | 1 (0.5) |
Acebutolol | C07AB04 | Beta blocking agents | 1 (0.5) |
Mirabegron | G04BD12 | Urologicals | 1 (0.5) |
Ibandronic acid | M05BA06 | Drugs affecting bone | 1 (0.5) |
Levodopa/Benserazide | N04BA02 | Dopaminergic agents | 1 (0.5) |
Selegiline | N04BD01 | Dopaminergic agents | 1 (0.5) |
Moxonidine | C02AC05 | Antiadrenergic agents | 1 (0.5) |
Irbesartan | C09CA04 | ACE inhibitors | 1 (0.5) |
Perindopril/Amlodipine | C09BB04 | ACE inhibitors combination | 1 (0.5) |
Cilazapril | C09AA08 | ACE inhibitors | 1 (0.5) |
Fluphenazine | N05AB02 | Antipsychotics | 1 (0.5) |
Ropinirole | N04BC04 | Dopaminergic agents | 1 (0.5) |
Chlorprothixene | N05AF03 | Antipsychotics | 1 (0.5) |