Deprescribing medicines in the acute setting to reduce the risk of falls

Abstract

BackgroundFalls are a common cause of morbidity and hospitalisation in older people. Inappropriate prescribing and polypharmacy contribute to falls risk in elderly patients. This study's aim was to quantify the problem and find out if medication review in the hospital setting led to deprescribing of medicines associated with falls risk.MethodsAdmissions records for elderly patients were examined to identify those whose presenting complaint included a fall. Inpatient medication charts, pharmaceutical care notes, medical notes and discharge summaries were examined to identify any falls-risk medicines from admission histories and to determine if any medication review took place, and whether or not changes were made as a result. In particular deprescribing and dose reduction details were analysed.Results100 patients over 70 years old were admitted following a fall during the 2 months study period. The mean number of medicines on admission was 6.8 per patient with polypharmacy found in 62/100 (62%). One or more falls-risk medicine was found in 65/100 (65%) patients. Medicines review was carried out in 86/100 (86%) of patients, and 59/697 (8.5%) medicines were deprescribed. Pharmacist involvement in medication review led to a significant reduction in the number of falls-risk medicines per patient (p=0.002).ConclusionsInappropriate prescribing and polypharmacy are found frequently in elderly patients at admission following a fall. Comprehensive medicines reviews should be carried out in all such patients with the objective of deprescribing or reducing doses to minimise risk of harm. Involvement of a pharmacist improves the rate of reduction of falls-risk medicines.

Pharmacotherapy as major risk factor of falls - analysis of 12 months experience in hospitals in South Bohemia

“…The benefits of a clinical pharmacist as an expert on drug management in various healthcare settings are evident (Cheema et al, 2018), however, there is no published, clear evidence about clinical pharmacy service in context of falls in the Czech Republic, and not even in abroad. Since drugs are a modifiable risk factor of falls, medication review should be incorporated in fall prevention programs (de Jong et al, 2013), and therefore it is important to strengthen pharmacist-conducted interventions in minimization of drug-related falls in both ambulatory (Bartlett et al, 2015;Mott et al, 2016) and inpatient settings in all risk groups (Browne et al, 2014;Marvin et al, 2017). Moreover, Marvin et al showed that pharmacist involvement in medication review in fact resulted in a significant reduction in the number of FRIDs per patient (Marvin et al, 2017).…”

Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity

“…This sample size provides a 95% confidence interval of 3.0% around the estimate of the quantity of deprescribing. As there are no estimates of deprescribing prevalence in usual hospital care, the estimate is based on a UK deprescribing intervention trial reporting 8.5% of admission medicines deprescribed [8]. Accepting this will be lower in the absence of an intervention, we estimated a maximum of 5.0% admission medicines likely to be deprescribed.…”

A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial

“…However, there are several important gaps in our current knowledge. First, few interventions have been initiated in the hospital setting, and no interventions have deprescribed across the continuum of acute and post-acute care [54,[56][57][58][59]. Second, few trials have incorporated patient preferences into the decision-making process [60][61][62][63].…”