Medication use and fall-risk assessment for falls in an acute care hospital.

AIM: A nested case-control study was carried out to examine relationships of a fall-risk score and the use of single medications and polypharmacy with falls among hospitalized patients aged 50 years and older in Taiwan. METHODS: There were 83 patients who experienced a fall during hospitalization in an acute-care hospital. Matched by age and sex, five control patients for each case were randomly selected from all other inpatients who had not experienced any fall at the time of the index fall. RESULTS: Patients who took tricyclic antidepressants, diuretics, and narcotics were 3.36-, 1.83- and 2.09-fold, respectively, more likely to experience a fall than their counterparts. Conversely, patients who took beta-blockers were 0.34-fold more likely than those who did not take them to experience a fall. Patients taking ≥6 medications were 3.08-fold more likely than those taking fewer medications to experience a fall, whereas those with anxiety were 4.72-fold more likely to experience a fall than those without. A high fall-risk score was not significantly associated with the occurrence of falls. CONCLUSIONS: Among older hospitalized patients, tricyclic antidepressants, diuretics, narcotics, and polypharmacy should be mindfully prescribed and reviewed on a regular basis. A fall-risk scale developed from community-dwelling older people might not accurately predict falls in hospitalized patients. Further research to validate the negative effect of beta-blocker use on falls is required.

Effect of fracture type on health-related quality of life among older women in Taiwan.

OBJECTIVE: To investigate changes in health-related quality of life (HRQOL) during the first year after injury in elderly Taiwanese women who had fractured a hip, vertebra, distal forearm, or multiple sites. DESIGN: Longitudinal cohort study. SETTING: Personal or telephone interviews of patients from 3 teaching hospitals. PARTICIPANTS: Women (N=347; mean age ± SD, 78.0±6.6y) who had sustained a fracture of the hip, vertebra, or distal forearm due to a fall participated in the baseline assessment, in which both current and prefracture HRQOL data were collected. At 6 and 12 months after the fracture, 285 and 254 women, respectively, completed the follow-up assessments. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The 4 domains of physical capacity, psychological well-being, social relationships, and environment of the brief version of the World Health Organization Quality of Life questionnaire were assessed. RESULTS: After adjusting for prefracture HRQOL scores and baseline characteristics, women with a hip fracture showed a significant improvement in physical capacity (3.5 points) and a significant decline in social relationships (-3.7 points). Relative to women with a hip fracture at 12 months after injury, those with a vertebral fracture exhibited significantly greater improvement (5.2 points) in physical capacity; those with a distal forearm fracture had significantly greater improvements in physical capacity (11.5 points), psychological well-being (8.4 points), social relationships (7.2 points), and environment (10.9 points), while those with multiple fractures displayed significantly greater improvement in physical capacity (16.5 points), psychological well-being (13.3 points), and environment (10.3 points). CONCLUSIONS: Among the 4 fracture types in elderly women, hip fractures may result in the smallest improvement in the physical domain and the greatest declines in the psychological, social, and environmental domains during the first year. The magnitude of the impact of each fracture type varied across different domains.

Use of quantitative ultrasound for identifying low bone density in older people.

OBJECTIVE: This study examined criterion, convergent, and discriminant validities of quantitative ultrasound (QUS) for identifying low bone density among people aged 55 years and older in Taiwan. METHODS: We recruited 453 community-dwelling volunteers and 30 patients with lower extremity fractures. Bone density was assessed using both calcaneal QUS and femoral neck dual-energy x-ray absorptiometry (DXA). Two QUS parameters, speed of sound (SOS) and broadband ultrasound attenuation (BUA), were also used to estimate heel bone mineral density (HBMD). RESULTS: Using DXA as the criterion for identifying low bone density (DXA T score of 1.0 or lower), likelihood ratios for BUA and SOS at the 50th percentile and HBMD for men were 1.50, 1.75, and 1.28, respectively; the counterparts for women were 1.54, 2.13, and 1.29. As for identifying osteoporosis (DXA T score of -2.5 or lower), higher likelihood ratios of the 3 QUS parameters were gained. For convergent validity, Pearson correlation coefficients for DXA with BUA, SOS, and HBMD ranged from 0.40 to 0.43 for men and from 0.48 to 0.53 for women. For the ability to discriminate men and women with lower extremity fractures from those without, no significant differences in the area under the receiver operating characteristic curve were detected between BUA, SOS, and HBMD and DXA after adjusting for age, body mass index, fall history, and current smoking. CONCLUSIONS: Although having very good convergent and discriminant validities and fair criterion validity, calcaneal QUS may be a screening tool for identifying low bone density.

A preliminary investigation of the association between serum uric acid and impaired renal function.

BACKGROUND: Hemodialysis for end-stage renal disease (ESRD) incurs huge medical costs in Taiwan. We set out to determine if it is possible to help control chronic renal disease with early treatment of hyperuricemia. METHODS: Data from Taipei Medical University Hospital (TMUH) health center from January 2004 to December 2006 were analyzed to correlate renal function and blood uric acid concentration. Patients were divided into 5 groups according to their serum uric acid concentration (< 4; 4 approximately 5.9; 6 approximately 7.9; 8 approximately 9.9, and > 10 mg/dl). According to our laboratory data, elevated serum creatinine levels (> 1.3 mg/dL) indicated impaired renal function. RESULTS: In total, there were 5722 patients, including 2816 (49.2%) men and 2906 (50.8%) women, with a median age of 67. Impaired renal function was noted in 307 (5.4%) cases. Serum uric acid was significantly correlated with blood urea nitrogen and serum creatinine. Groups with a higher serum uric acid level had an increased risk of impaired renal function. CONCLUSION: Our purpose in this preliminary observation was to try to define a starting point for the early control of serum uric acid, in order to avoid the development of impaired renal function. We found that serum uric acid level to < 6 mg/dl seemed to be associated with less renal function impairment.