Einfluss von andauerndem Schmerz und Medikamenten auf das Sturz- und Frakturrisiko

Zusammenfassung

Die Prävalenz von Schmerzen steigt mit dem Alter, ebenso wie die Anzahl der gleichzeitig vorliegenden Erkrankungen. Diese Multimorbidität triggert zudem die Verordnung zahlreicher Medikamente. Diese sog. Polypharmazie oder die Verordnung bestimmter Medikamentengruppen wie Analgetika, Hypnotika oder Antidepressiva sind mit der Häufigkeit von Sturzereignissen und Frakturen assoziiert. Diese Assoziation verleitet dazu, durch eine Reduktion der Anzahl der verordneten Medikamente ungünstige Ereignisse zu verhindern. Die Evidenz für diesen Ansatz konnte in randomisierten Studien jedoch nicht erbracht werden. Das Management der Medikation im Alter erfordert eine klare Indikation für ein Präparat, die regelmäßige Überprüfung dieser Indikation und die Auswahl des am besten verträglichen Präparates.

Abstract

The prevalence of pain increases with age, as does the number of co-existing diseases. This multimorbidity also triggers the prescription of numerous drugs. This so-called polypharmacy or the prescription of certain groups of drugs such as analgesics, hypnotics or antidepressants are associated with the frequency of falls and fractures. This association leads to the idea to prevent adverse events by reducing the number of drugs prescribed. However, the evidence for this approach could not be provided in randomized studies. Medication management in old age requires a clear indication for a drug, regular review of this indication, and selection of the most well-tolerated drug.

Schlüsselwörter

Andauernder Schmerz - Polypharmazie - Sturzereignisse - Frakturen - höheres Lebensalter

Key words

Persistent pain - polypharmacy - falls - fractures - advanced age

Publication History

Received: 11 September 2023

Accepted: 21 November 2023

Article published online:
20 February 2024

• Literatur

• 1 [Anonymous]. Pharmacological management of persistent pain in older persons. Pain Med 2009; 10: 1062-1083 DOI: 10.1111/j.1526-4637.2009.00699.x.
• 2 Bauer H, Emeny RT, Baumert J. et al. Resilience moderates the association between chronic pain and depressive symptoms in the elderly. Eur J Pain 2016; 20: 1253-1265 DOI: 10.1002/ejp.850.
• 3 Zanocchi M, Maero B, Nicola E. et al. Chronic pain in a sample of nursing home residents: prevalence, characteristics, influence on quality of life (QoL). Arch Gerontol Geriatr 2008; 47: 121-128 DOI: 10.1016/j.archger.2007.07.003.
• 4 Deandrea S, Lucenteforte E, Bravi F. et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 2010; 21: 658-668 DOI: 10.1097/EDE.0b013e3181e89905.
• 5 Deandrea S, Bravi F, Turati F. et al. Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr 2013; 56: 407-415 DOI: 10.1016/j.archger.2012.12.006.
• 6 Farrell B, Shamji S, Ingar N. Reducing fall risk while managing pain and insomnia: Addressing polypharmacy in an 81-year-old woman. Can Pharm J (Ott) 2013; 146: 335-341 DOI: 10.1177/1715163513504529.
• 7 Frohnhofen H, Michalek C, Wehling M. Bewertung von Medikamenten in der Geriatrie mit der neuen FORTA-Klassifikation. Dtsch Med Wochenschr 2011; 136: 1417-1421 DOI: 10.1055/s-0031-1281530.
• 8 Wehling M, Burkhardt H, Kuhn-Thiel A. et al. VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing 2016; 45: 262-267 DOI: 10.1093/ageing/afv200.
• 9 Rankin A, Cadogan CA, Patterson SM. et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2018; 9: CD008165 DOI: 10.1002/14651858.CD008165.pub4.
• 10 Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr 2023; 23: 385 DOI: 10.1186/s12877-023-03855-9.
• 11 Welch SA, Ward RE, Beauchamp MK. et al. The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients. J Am Med Dir Assoc 2021; 22: 1646-1651 DOI: 10.1016/j.jamda.2020.09.038.
• 12 Vieira ER, Palmer RC, Chaves PHM. Prevention of falls in older people living in the community. BMJ 2016; 353: i1419 DOI: 10.1136/bmj.i1419.
• 13 Stubbs B, Schofield P, Binnekade T. et al. Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis. Pain Med 2014; 15: 1115-1128 DOI: 10.1111/pme.12462.
• 14 Stubbs B, Binnekade T, Eggermont L. et al. Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Arch Phys Med Rehabil 2014; 95: 175-187.e9 DOI: 10.1016/j.apmr.2013.08.241.
• 15 Cai Y, Leveille SG, Andreeva O. et al. Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach. J Gerontol A Biol Sci Med Sci 2023; DOI: 10.1093/gerona/glad130.
• 16 Shao L, Shi Y, Xie X. et al. Incidence and Risk Factors of Falls Among Older People in Nursing Homes: Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; DOI: 10.1016/j.jamda.2023.06.002.
• 17 Kobayashi K, Ando K, Nakashima H. et al. Relationship between use of sleep medication and accidental falls during hospitalization. Nagoya J Med Sci 2021; 83: 851-860 DOI: 10.18999/nagjms.83.4.851.
• 18 Stone KL, Ensrud KE, Ancoli-Israel S. Sleep, insomnia and falls in elderly patients. Sleep Med 2008; 9: S18-S22 DOI: 10.1016/S1389-9457(08)70012-1.
• 19 Mahgoub N, Majdak P, Friedman DB. et al. Insomnia and risk of falling in older adults. J Neuropsychiatry Clin Neurosci 2012; 24: E5-E6 DOI: 10.1176/appi.neuropsych.11070159.
• 20 Hamrick I, Norton D, Birstler J. et al. Association Between Dehydration and Falls. Mayo Clin Proc Innov Qual Outcomes 2020; 4: 259-265 DOI: 10.1016/j.mayocpiqo.2020.01.003.
• 21 Yang Y, Hu X, Zhang Q. et al. Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis. Age Ageing 2016; 45: 761-767 DOI: 10.1093/ageing/afw140.
• 22 Wehling M. Morbus diureticus in the elderly: epidemic overuse of a widely applied group of drugs. J Am Med Dir Assoc 2013; 14: 437-442 DOI: 10.1016/j.jamda.2013.02.002.
• 23 Machado GC, Maher CG, Ferreira PH. et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015; 350: h1225 DOI: 10.1136/bmj.h1225.
• 24 Makris UE, Abrams RC, Gurland B. et al. Management of persistent pain in the older patient: a clinical review. JAMA 2014; 312: 825-836 DOI: 10.1001/jama.2014.9405.
• 25 Söderberg KC, Laflamme L, Möller J. Newly initiated opioid treatment and the risk of fall-related injuries. A nationwide, register-based, case-crossover study in Sweden. CNS Drugs 2013; 27: 155-161 DOI: 10.1007/s40263-013-0038-1.
• 26 Lee J, Negm A, Peters R. et al. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open 2021; 11: e035978 DOI: 10.1136/bmjopen-2019-035978.
• 27 Orrillo E, Vidal Neira L, Piedimonte F. et al. What Is New in the Clinical Management of Low Back Pain: A Narrative Review. Cureus 2022; 14: e22992 DOI: 10.7759/cureus.22992.
• 28 Mol A, Bui Hoang PTS, Sharmin S. et al. Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 20: 589-597.e5 DOI: 10.1016/j.jamda.2018.11.003.
• 29 Ringe JD, Body J-J. A review of bone pain relief with ibandronate and other bisphosphonates in disorders of increased bone turnover. Clin Exp Rheumatol 2007; 25: 766-774 Review
• 30 Luegering A, Frohnhofen H, Langner R. et al. Problems in Medication Self-Management by Elderly Patients. Dtsch Arztebl Int 2023; 120: 559-560 DOI: 10.3238/arztebl.m2023.0144.
• 31 Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 2010; 107: 543-551 DOI: 10.3238/arztebl.2010.0543.
• 32 Wehling M. How to Use the FORTA ("Fit fOR The Aged") List to Improve Pharmacotherapy in the Elderly. Drug Res (Stuttg) 2016; 66: 57-62 DOI: 10.1055/s-0035-1549935.
• 33 Pazan F, Wehling M, Weiss C. et al. Medication optimization according to the Fit fOR The Aged (FORTA) rules improves functional status in patients hospitalized for geriatric rehabilitation. Eur Geriatr Med 2023; 14: 477-483 DOI: 10.1007/s41999-023-00779-w.