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Marcum, Zachary and Castle, Nicholas and Hanlon, Joseph and Perera, Subashan and Thorpe, Joshua and Switzer, Galen E (2014) MEDICATION USE AND FALLS IN OLDER ADULTS: A PHARMACOEPIDEMIOLOGIC APPROACH. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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More than one-third of community-dwelling older adults fall each year. Falling is classified as a geriatric syndrome which has multiple contributing factors and an interaction between chronic predisposing diseases and impairments and acute precipitating insults. One potentially modifiable risk factor is medication use. While previous research has been conducted on medication-related falls, there are several gaps remaining in the literature, including the lack evidence on dose-response relationships across wide ranges of medication classes and falls as well as the frequent inability to address confounding by indication. Therefore, the overall purpose of this project was to determine—in a large, representative sample of community-dwelling older adults—associations between antihypertensive, anticholinergic, and antidepressant use and recurrent falls.
First, we found no increased risk of recurrent falls in antihypertensive users compared to non-users, or those taking higher doses or for longer durations. Only those using a loop diuretic were found to have a modest increased risk of recurrent falls. In conclusion, antihypertensive use overall was not associated with recurrent falls after adjusting for important confounders. Loop diuretic use may be associated with recurrent falls and needs further study.
Second, we found no statistically significant increased risk of recurrent falls in anticholinergic users, or those taking higher doses or for longer durations. In conclusion, increased point estimates suggest an association of anticholinergic use with recurrent falls, but the associations did not reach statistical significance. Future studies are needed to examine other measures of anticholinergic burden, and their associations with other outcomes such as cognitive function.
Third, we found a statistically significant increased risk of recurrent falls in antidepressant users. An increased risk was also seen among those taking SSRIs, those with short duration of use, and those taking moderate doses. Among those with a history of falls/fracture at baseline, we found an increase in risk for any antidepressant use, but no increased risk was found in those without a history of falls/fracture.
Taken together, the findings from this proposal will provide clinicians and researchers with clinically-relevant information on potential harmful outcomes associated with chronic medication therapy among older adults.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Marcum, Zacharyzam12@pitt.eduZAM12
Castle, Nicholascastlen@pitt.eduCASTLEN
Hanlon, Josephjth14@pitt.eduJTH14
Perera, Subashanksp9@pitt.eduKSP9
Thorpe, Joshuajmthorpe@pitt.eduJMTHORPE
Switzer, Galen Eswitzerge@upmc.eduGSWITZER
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairThorpe, Joshuajmthorpe@pitt.eduJMTHORPE
Thesis AdvisorSwitzer, Galenswitzerge@upmc.eduGSWITZER
Committee MemberCastle, Nicholascastlen@pitt.eduCASTLEN
Committee MemberHanlon, Josephjth14@pitt.eduJTH14
Committee MemberPerera, Subashanksp9@pitt.eduKSP9
Date: 13 October 2014
Date Type: Publication
Defense Date: 26 September 2014
Approval Date: 13 October 2014
Submission Date: 3 October 2014
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 81
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Clinical and Translational Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: older adults; falls; medication; pharmacoepidemiology; community-dwelling; pharmacy
Date Deposited: 13 Oct 2014 17:36
Last Modified: 19 Dec 2016 14:42


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