The relationship between the use of medication and fall among the elderly (Research Paper Sample)

INTRODUCTION A fall can be defined as unintentionally coming to rest on the ground or other lower levels with or without loss of consciousness. Falls among the elderly remain an ever increasing problem. Age-related changes and disease both have an impact on an older person's ability to balance. Similarly, cognitive impairment, various medications, and changes in a person's environment all appear to contribute to increased risk of falling. Falls in the elderly are a public health and community problem with adverse physical, medical, psychological, social and economic consequences. These include disability and deformity, fear of repeated falls, curtailment of routine social activities, direct costs of medical care associated with injuries and loss of potential income. There has been a doubling of the hospital admission rate for patients 65 years and above with a hip fracture in the Netherlands during the last 20 years. This has resulted in an enormous increase in the costs of intramural and extramural healthcare. In addition to an influence on morbidity and mortality, falls have a negative effect on daily life activities and quality of life. This is especially so when the fear of falling leads to avoidance behaviour, which promotes inactivity with a further deconditioning of musculoskeletal function, propensity to inactivity and social isolation, all facilitating new falls. In the elderly, falls represent a multifactorial problem which should be regarded as the result of complex interactions between intrinsic factors and factors relating to environment and the specific situation. The independent variable in this case is medication use as the cause of falls among the elderly and the dependent variables are those illnesses that are as a result of old age. Judicious application of medications that enhance the likelihood of falling probably contributes to prevention of an important cause of morbidity in the elderly. Recent data from the Dutch Foundation for Pharmaceutical Statistics (SFK) have revealed that salicylates used as an antiplatelet agent, temazepam, furosemide and oxazepam are among the medicines most frequently taken by elderly patients aged 65 years and above. Pathophysiology of orthostatic hypotension is discussed and changes in the pharmacokinetics and pharmocodynamics due to ageing are addressed. A focus will be on the evidence currently available on medication as a risk factor for the occurrence of dizziness and falls. Literature review A fall also can be defined as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force. Falling is a common serious medical condition that affects the health of elderly persons. Current literature suggests that the problem is of concern in both the developed and the developing world. In Australia, it is estimated that about a third of the elderly living in the community experience at least one fall annually. Gillespie citing studies from the USA corroboratively asserts that more than 30% of people aged 65 or older living in the community fall each year, and that the risk of falling increases with age. Statistics from Ontario, Canada indicate that one-third to one-half of persons over 65 are prone to falling, with falls being more common in older females. From the developing world, data are now emerging that suggest falls among the elderly is a growing problem and of significant public health concern. Falls in the elderly in China has been described as a very common complication in social life. Based on a prospective cohort study in Hong Kong among older adults, the prevalence and incidence of falls were determined to be 19.3% per year and 270 per 1000 person-years respectively; with recurrent falls happening in 4.75% of Chinese older adults every year. In Africa, one population-based survey from Tanzania that examined the injury morbidity in an urban and a rural setting indicated that among persons over sixty years old, falls accounted for about 35% of reported injuries in both settings. In Latin America and the Caribbean, analysis of data from the SABE study on Aging, Health, and Well-being conducted in seven cities across the region, reported the prevalence of falls as varying from 21.6% in Bridgetown (Barbados) and 29% in Havana (Cuba) to 33% in Mexico City (Mexico) and 34% in Santiago (Chile). The number of elderly is increasing most rapidly in Asia, Latin America, the Middle East, and Africa. Developing countries will continue to experience rapid population aging in the coming decades and by 2025, there will be 839 million older people living in developing countries, 500 million more than will be living in developed countries. Melton has predicted that the mentioned regions will account for over 70% of the 6.26 million hip fractures expected in the year 2050. Moreover, about 90 percent of hip fractures are associated with a fall, with the vast majority of such falls being from a standing height or less. Consequently, there is increasing imperative to address falls and fall prevention among the elderly in developing countries such as South Africa. causes Some of the intended and unintended pharmacological effects of drug therapy such as sedation, psychomotor impairment, cognitive changes, dizziness, and orthostatic hypotension might be expected to increase the risk of falls. Numerous published studies have sought to establish an association between medication use and risk of falling. MEDICAL CAUSES AND RI SK FACTORS FOR FALLS Theoretically, randomized controlled trials are likely to provide the evidence to prove the causal relationship between medication use and falls. When addressing the specific cause of falls, the rate of falls must be known both in the intervention and the control group but such evidence is only rarely available. Data on the relationship between drugs and falls are usually derived from observational studies, for instance from cohort or patient-controlled studies, rendering interpretation of results difficult. The majority of studies and reports available suggest a relationship between number of medications and the risk of fall. Also a recent change in dosage of drugs is associated with an increased risk of falls. The use of psychotropic medication is regarded as a risk factor for falls. Psychoactive medication likely contributes to the occurrence of falls by affecting balance, partly because of the extrapyramidal side effects, dizziness and postural hypotension in addition to a delayed reaction time, with a higher incidence if combinations of medications are used. A fall resulting in hospital admission in the elderly is likely to be regarded as a side effect of drug treatment. The risk of falls in the elderly is increased with postural instability, regardless of the cause which can range from acute illness with fever and dehydration, the use of a specific drug affecting plasma volume or the reaction time to floor covering. The risk of a second fall within one year is increased especially in elderly individuals on benzodiazepines, antidepressants, neuroleptics or anticonvulsants Meta-analyses Leipzig et al.(1999) published two meta-analyses in an attempt to clarify some of the issues surrounding medication use and falls. In the first study, the authors identified 40 trials, between 1966 and 1996, that evaluated the association between the use of sedative or hypnotic agents, antidepressants, neuroleptics, and psychotropic drugs and the risk of falls in people who were 60 years of age and older. None of the studies was a randomized, controlled trial, which is a significant limitation in the literature on this topic. When the authors analyzed the pooled data and calculated the odds ratios, they found a significant relationship between the use of psychotropic drug as a group as well as for the various classes of psychotropic drugs and one or more falls. In the second study, the authors identified 29 trials, in the same time period, that evaluated the association between the use of several classes of cardiovascular or analgesic drugs and falls in people 60 years of age and older. Again, none of these studies was a randomized, controlled trial. The authors found a significant relationship between the risk of falls and the use of type-IA antiarrhythmic agents, digoxin, and diuretics only but not between falls and angiotensin-converting enzyme inhibitors, calcium-channel blockers, beta blockers, centrally acting antihypertensive agents, and nitrates. No significant association was found between the use of any of the analgesic drug classes analyzed and the risk of falls. According to these results of the meta-analyses, psychotropic drugs had the strongest association with falls, with cardiac and analgesic drugs having little or no correlation. The authors also found that patients using three or more medication appeared to be at an increased risk for recurrent falls. METHODOLOGY Research design The study would be a qualitative and quantitative research. The extent to which the literature from South Africa provides supporting empirical evidence is not fully known and is perhaps sparse thus I would employ a number of research methods and strategies to provide evidence and insights regarding falls among the elderly in South Africa. These would include a search and review of existing literature, docket and patient information reviews, focus groups, interview with an expert and case histories. I would design tools to elicit information from focus groups, individual clients and patient records. Search Methodology I would do a comprehensive literature search on articles from carribean and latin America articles on causes of fal...