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Master Thesis

Polymédication et sévérité de la chute chez les personnes âgées admises aux urgences : étude observationnelle analytique rétrospective au CHU de Guadeloupe

Abstract : Introduction: Fall is a common geriatric syndrome within the elderly. It is a predictive factor of adverse health events (hospitalization, loss of independence, institutionalization, death…). Polypharmacy is a risk factor for falls and is also recognized as a risk factor for resorting to a hospital structure, but only few studies have examined the severity of the fall in the elderly. The objective of this study was to assess if polypharmacy was associated with the severity of the fall in patients aged 70 and over in an emergency department. Methods: All cases corresponding to a fall were extracted from the database of the emergency department of University Medical Center of Guadeloupe, using keyword research between May 1st 2018 and April 30th 2019.The characteristics of each case were studied from the emergency report. The severity of the fall was defined by hospitalization or death, and polypharmacy was defined by the presence of 6 or more drugs. Bi-varied analyzes between the severity of the fall and each variable were performed. The analyzes were performed using R software version 3.0.2. Results: During the study period, 625 patients were included. Two hundred seventy-seven patients (44.3%) required hospitalization, while 348 (55.7%) returned at home. Three patients died during their emergency stay. Overall, 39.7% of patients met the definition of polypharmacy. Polypharmacy was statistically associated with the severity of the fall (OR: 1.63 [95% CI: 1.33-2.02]). The other studied factors (gender, history of falling, alcohol, dependence, etc…)were not associated with the severity of the fall, even the excessive polypharmacy (OR: 1.49 [95% CI: 0.78-2.82]) compared to the lack of polypharmacy. When the number of drugs was ranged into 4 categories (0-3 (ref.), 4-6, 7-9 and ≥ 10), the associated OR were respectively 1.46 [0.99 –2.14], 1.65 [1.09–2.50] and 1.48 [0.76–2.85]. The drug prescription was revised for 5 of the 348 (1.44%) patients who returned home. Conclusion: Polypharmacy was the only factor associated with the severity of the fall in our study. The relationship between the number of prescription drugs and severity seems linear, except for excessive polypharmacy. A further study with a larger excess polypharmacy number is needed to confirm or deny the persistence of the relationship with severity beyond 10 treatments. Regarding clinical practice, revision of the prescription is essential to reduce polypharmacy in the elderly, to reduce the risk of fall-related hospitalizations.
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Master Thesis
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Guillaume Mallet. Polymédication et sévérité de la chute chez les personnes âgées admises aux urgences : étude observationnelle analytique rétrospective au CHU de Guadeloupe. Médecine humaine et pathologie. 2019. ⟨dumas-02941066⟩

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