Use of Falls Risk Increasing Drugs in older people, before and after hospitalisation with a fall

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P Crawford1,2; R Plumb2,3; P Burns1; S Flanagan1; M Devlin1; C McParland1; M Smyth1; C Crawley1; A McGrath1; L Dolan1; C Conroy1; C Morris1; C Gallen1; C Fannin1; A Glass1; J Barrett1; C Marner1; M McFarland1; C Parsons2.
1. Medicines Optimisation Older People (MOOP) Pharmacy team & Clinical Pharmacy Team, Belfast HSC Trust; 2. School of Pharmacy, Queen's University Belfast (QUB); 3. School of Medicine, Dentistry & Biomedical Sciences QUB, & Belfast HSC Trust.
Scientific Research
SP - Falls

Abstract

Introduction:

World Guidelines for Falls Prevention & Management for Older Adults[1] recommends medication review as part of multifactorial risk assessment for those at high risk of falling. Use of Falls Risk Increasing Drugs (FRIDs) [2], polypharmacy and anticholinergic burden are known to increase risk of falls in older people [3]. This prospective observational study was conducted to assess if polypharmacy, prescription of FRIDs and anticholinergic burden [4] improve after hospitalisation with a fall.

Method:

Data gathered from electronic medication records once necessary ethical approvals in place, for patients aged ≥ 65 years, taking ≥4 medicines, at hospital admission with a fall, at discharge, and 3 months after discharge included number of medications prescribed, number of Falls Risk Increasing Drugs (FRIDs) prescribed [2] and anticholinergic burden (ACB) score [4]. 

Results:

Patients were included from March 2023 until May 2024 (n=113). Mean age was 81±8.58 years and 80% of patients were female (n=90). The mean number of medicines per patient was 8.05±0.37(SE) at hospital admission, increasing by 32% to average 10.66±0.39(SE), three months after discharge (p<0.001). The mean number of FRIDs per patient increased by 7.8% from 2.44±.16(SE) at hospital admission to 2.63±.17(SE) three months after discharge (p=0.057).

Most common FRIDs were bisoprolol, furosemide, codeine, amlodipine and amitriptyline. Codeine was the most common FRID started after discharge (n=13; 12% of patients).

ACB score increased by 18% to 2.40± 0.21(SE) at 3 months following discharge compared to 2.04±0.21(SE) at admission (p=0.003). Furosemide, codeine, amitriptyline, sertraline and diazepam were the top medicines with anticholinergic burden.

Conclusion:

Three months after discharge from hospital following a fall, older people experience increased polypharmacy and anticholinergic burden and are prescribed more Falls Risk Increasing Drugs, compared to at the time of hospital admission.

  1. Montero-Odasso, M., van der Velde, N., Martin, F.C. et al. (2022) The Task Force on Global Guidelines for Falls in Older Adults, World Guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing, 51, 9.
  2. Saeed, D., Carter, G., Miller, R. et al. (2024) Development and Delphi consensus validation of the Medication-Related Fall (MRF) screening and scoring tool, International Journal of Clinical Pharmacy, 46, pp. 977–986 https://doi.org/10.1007/s11096-024-01734-w
  3. National Institute Health and Clinical Excellence (NICE). 2013 Falls in Older People: Assessing risk and prevention Guidance. www.nice.org.uk
  4. Anticholinergic Burden Calculator web app (ACBcalc®) created by Dr Rebecca King and Steve Rabino