Excess risk of falls and fractures amongst older people with sedative-hypnotic polypharmacy: an analysis of Korean National Health Insurance Senior Cohort Database.

BACKGROUND

The rapid ageing of South Korea has led to a growing use of sedative-hypnotic drugs (SHDs) amongst older people, raising concerns about SHD polypharmacy and the increased risk of falls or fractures.

OBJECTIVE

This study examined the prevalence of SHD polypharmacy and its association with falls or fractures amongst older population in South Korea.

METHODS

Using the National Health Insurance Service Senior Cohort Database 2.0 (2002-2019), we identified individuals aged 65 and older in 2017. We conducted 1:1 propensity-score matching to compare SHD users (n = 211 451) with non-users. Multivariable logistic regression analyses were conducted, adjusting for osteoporosis, fracture history and comorbidities.

RESULTS

Amongst SHD users, 15.28% were prescribed two SHD active pharmaceutical ingredients (APIs) concurrently, and 6.49% received three or more; 15.63% were prescribed two SHD categories, and 4.84% received three or more. The risk of falls or fractures increased with the number of SHDs used. Patients prescribed two SHD APIs had an adjusted odds ratio (aOR) of 1.185 (95% confidence interval [CI]: 1.142-1.230) of having a diagnosis of fall or fracture, and those receiving three or more had an aOR of 1.333 (95% CI: 1.266-1.404), compared to those on a single API. Similar trends were seen when analysing by drug category.

CONCLUSIONS

SHD polypharmacy is common amongst Korean older population and is associated with a drug count-dependent increase in the risk of falls and fractures. These findings highlight the need for safer prescribing practices and increased attention to prevent falls or fractures amongst older individuals experiencing SHD polypharmacy.