Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults

Abstract

Background Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’. Methods Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded. Results Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases. Conclusion FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.