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Articles by J Gribbin
Total Records ( 2 ) for J Gribbin
  J Gribbin , R Hubbard , J. R. F Gladman , C Smith and S. Lewis

Background: antihypertensive medications have long been implicated as a potential cause of falls in older people but, despite their widespread prescribing, the size of class-specific adverse effects remains unclear.

Aim: to determine the role of antihypertensive medications in older people with a recorded fall in primary care.

Design: case–control study.

Setting: UK general practices contributing data to The Health Improvement Network primary care database.

Methods: patients over 60 years of age with a first fall recorded between 2003 and 2006 were selected, and up to six controls per case matched by age, gender and general practice. We used conditional logistic regression to estimate odds ratios for ever exposure, and current/previous exposure to the main classes of antihypertensives, adjusting for co-morbidity. We also examined the effect of the time interval from first prescription to first fall.

Results: amongst our 9,682 cases, we found an increased risk of current prescribing of thiazides (odds ratio (OR) 1.25; 95% confidence interval 1.15–1.36). At 3 weeks after first prescribing the risk remained 4.28 (1.19–15.42). We found a reduced risk for current prescribing of beta blockers (OR 0.90; 0.85–0.96). There was no significant association with current prescribing of any other class of antihypertensive.

Conclusions: the study provides evidence that current prescribing of thiazides is associated with an increased risk of falling and that this is strongest in the 3 weeks following the first prescription.

  J Gribbin , R Hubbard , C Smith , J Gladman and S. Lewis

Background: Despite the role of primary care in the falls care pathway, there are almost no data on the extent of falls seen in general practices.

Aim: To quantify the incidence and mortality of falls amongst older people in primary care in the UK.

Methods: Cohort study of people aged >=60 years and registered in a UK practice contributing data to The Health Improvement Network primary care database (THIN) throughout 2003–06. Analysis of crude incidence and estimation of incidence rate ratios using negative binomial regression, and survival using Cox regression. Sensitivity analysis of criteria for distinguishing discrete fall events from follow-up appointments.

Results: Amongst people aged >=60 years the overall crude incidence rate of recorded falls was 3.58/100 person-years (95% CI 3.56–3.61). The rate of recurrent falls was 0.67/100 person-years (95% CI 0.66–0.68). The incidence rate of recorded falls and recurrent falls was higher in older age groups, in women and least advantaged social groups. Incidence of recorded falls was constant through the time period 2003–06. Mortality for recurrent fallers was about twice that of general population controls.

Conclusions: These data suggest that more than 475 000 fall events in older people are recorded in general practice each year in the UK, and are associated with increased mortality and relative deprivation. The underlying incidence rate has remained stable in recent years.

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