Potentially inappropriate medications and their effect on falls during hospital admission

Abstract

Objective to investigate the effect of potentially inappropriate medications (PIMs) on inpatient falls and to identify whether PIMs as defined by STOPPFall or the designated section K for falls of STOPP v2 have a stronger association with inpatient falls when compared to the general tool STOPP v2. Methods a retrospective observational matching study using an electronic health records dataset of patients (≥70 years) admitted to an academic hospital (2015–19), including free text to identify inpatient falls. PIMs were identified using the STOPP v2, section K of STOPP v2 and STOPPFall. We first matched admissions with PIMs to those without PIMs on confounding factors. We then applied multinomial logistic regression analysis and Cox proportional hazards analysis on the matched datasets to identify effects of PIMs on inpatient falls. Results the dataset included 16,678 hospital admissions, with a mean age of 77.2 years. Inpatient falls occurred during 446 (2.7%) admissions. Adjusted odds ratio (OR) (95% confidence interval (CI)) for the association between PIM exposure and falls were 7.9 (6.1–10.3) for STOPP section K, 2.2 (2.0–2.5) for STOPP and 1.4 (1.3–1.5) for STOPPFall. Adjusted hazard ratio (HR) (95% CI) for the effect on time to first fall were 2.8 (2.3–3.5) for STOPP section K, 1.5 (1.3–1.6) for STOPP and 1.3 (1.2–1.5) for STOPPFall. Conclusions we identified an independent association of PIMs on inpatient falls for all applied (de)prescribing tools. The strongest effect was identified for STOPP section K, which is restricted to high-risk medication for falls. Our results suggest that decreasing PIM exposure during hospital stay might benefit fall prevention, but intervention studies are warranted.

Potentially inappropriate medication use and associated factors in residents of long-term care facilities: A nationwide cohort study

“…The Beers Criteria, STOPP/START, NORGEP, and PRISCUS are representative guidelines ( Rognstad et al, 2009 ; Holt et al, 2010 ; O’Mahony et al, 2015 ; By the American Geriatrics Society Beers Criteria Update Expert, 2019 ). The use of PIMs in older adults is associated with ADRs, falls and fractures, hospitalizations, and increased healthcare costs ( Hyttinen et al, 2016 ; Damoiseaux-Volman et al, 2021 ; Yadesa et al, 2021 ). Thus, medication management to evaluate and prevent PIM use in older adults is important.…”

Prevalence and Predictors of Potentially Inappropriate Medications Among Patients Aged ≥65 Years on Hospital Admissions in Kuwait

“…6,7 However, our findings are not consistent with studies conducted in European countries who reported a lower prevalence of PIM using BC. 16,[34][35][36] One study conducted in Ireland examined the association between the detected PIM and ADEs in patients aged ≥65 years in hospitals. 16 That study revealed the prevalence of PIM prescriptions to be 28.8% by applying BC.…”

Performance of a trigger tool for detecting adverse drug reactions in patients with polypharmacy acutely admitted to the geriatric ward

“…To increase the PPV, we would rather suggest to explore strategies for excluding drugs with a relatively low risk on the clinical event. A recent observational study compared the association of potentially inappropriate medication on inpatient falls listed in the explicit screening tools STOPP v2, STOPP v2 section K, and STOPPFall [ 26 – 28 ] Although all screening tools were independently associated with falls, the strongest effect was identified for STOPP section K [ 28 ]. This is plausible because STOPP section K is the most restrictive tool, including only four drug classes with highest risk of falls (i.e.…”