Abstract
Introduction: Certain medications increase the risk of falls in older adults and there is evidence that identification and review of Fall Risk Increasing Drugs (FRIDs) in older adults using a structured approach can significantly reduce falls risk. Anticholinergic burden (ACB), the cumulative effect of medications with anticholinergic activity, is associated with an increased risk of falls in older adults. Studies show that higher ACB scores are linked to higher rates of falls and fractures.
Method: Patients admitted to an Older People’s admission ward with a fall as their presenting complaint and prescribed at least one FRID on admission were identified by a specialist pharmacy technician. Using a standardised template, the technician added a clinical note including the patient's FRIDs, ACB score and lying and standing blood pressures if completed. The ward pharmacist then completed a review of each medication that can increase falls risk with the patient and the medical team. The pharmacist or medical team then deprescribed or switched to a lower risk alternative where appropriate using the STOPP Falls deprescribing tool.
Results: A structured falls medication review was conducted in 106 patients over a 6 weeks period. Overall, 25% (n=27) of all patients had a reduction in their total ACB score and 48% (n=51) had a change made to their FRIDs during their inpatient stay. The changes made included cessation, dose reduction, and timing of administration. Of the patients whose FRIDs were changed, pharmacists were involved in 80% (n=41) of the changes and patients were involved in 74% (n=46) of the changes through shared-decision making.
Conclusion: A structured approach to identification, documentation, and review of FRIDs for patients admitted to hospital following a fall can reduce ACB score and increase de-prescribing of FRIDs.