Category: Professional Posters
Purpose: Many drugs, other than those associated with orthostatic blood pressure, may increase the risk of falling in elderly. In a Swedish study, the use of antidepressants and opioids, respectively, was associated with a 60 % increased risk of falling, while hypnotics showed a 13 % increased risk. Knowledge of all medications used by the patient is an important basis for risk minimization. However, the information we have on a patient’s medications is not always correct. In this study, we compare the information from patient’s medication list with substances detected in the blood of the patient at the time of falling.
Methods: One hundred consecutive patients with a hip fracture were included. A single blood sample was drawn at arrival to the emergency department of a university hospital. The samples were screened for over 500 commonly prescribed drugs and their metabolites by liquid chromatography/time of flight mass spectrometric analysis, LC-TOF-MS. Analyses were performed on an Agilent 6540 TOF-MS, in combination with a 1290 UHPLC. Information on prescribed medications was retrieved from the electronic health record at the time of the admittance to the hospital. Information on drugs given in the ambulance was also collected. Informed consent was retrieved from all participants and the study was approved by the regional Research Ethics Board.
Results: 95 out of 106 recruited hip fracture patients were followed up with TOF-screening. Mean age was 84 years; women (67%) and men (23%). Around one fourth of the patients lived in a special care facility Eighty out of 95 patients fell indoors. According to the medical records, the median number of prescribed drugs in the group was 7 (0-16). Three patients had no medications. Drugs known to have been given in the ambulance (ketobemidone, diazepam, phytonadione, metoclopramide, morphine, ketamine and ondansetron) were excluded in the interpretation of drug screening analyses.
In 95 patients, one or more of the prescribed drugs, e.g. enalapril, tolterodine or prednisolone, could not be detected in the blood sample. On the other hand, in 47 patients, other drugs than those registered in the health record were present in blood samples. The detected non-prescribed drugs were acetaminophen (17 patients), antidepressants (3 patients), opioids (4 patients), omeprazole (2 patients), metoprolol (2 patients) and cetirizine, ephedrine, donepezil and meclizine in one patient each. Ropivacaine or xylocaine, probably given but not documented in the ambulance, were also detected in 18 patients.
Conclusion: In 15 out of 95 patients with a hip fracture, drugs that may be associated with an increased risk of falling and/or fracturing were detected in a blood sample at arrival to the hospital, but were not recognized or registered in the medication list. This may be due to the patient being non adherent, or to shortcomings in communication or documentation of drugs taken or prescribed. Our findings support the need for a thorough medication review in connection to a fall, to minimize the risk for further accidents.