Change in central nervous system‐active medication use following fall‐related injury in older adults

Abstract

Background: Central nervous system (CNS)-active medication use is an important modifiable risk factor for falls in older adults. A fall-related injury should prompt providers to evaluate and reduce CNS-active medications to prevent recurrent falls. We evaluated change in CNS-active medications up to 12 months following a fall-related injury in community-dwelling older adults compared with a matched cohort without fall-related injury.Methods: Participants were from the Adult Changes in Thought study conducted at Kaiser Permanente Washington. Fall-related injury codes between 1994 and 2014 defined index encounters in participants with no evidence of such injuries in the preceding year. We matched each fallrelated injury index encounter with up to five randomly selected clinical encounters from participants without injury. Using automated pharmacy data, we estimated the average change in CNS-active medication use at 3, 6, and 12 months post-index according to the presence or absence of CNSactive medication use before index.Results: One thousand five hundred sixteen participants with fall-related injury index encounters (449 CNS-active users, 1067 nonusers) were matched to 7014 index encounters from people without fall-related injuries (1751 users, 5236 nonusers). Among CNS-active users at the index encounter, those with fall-related injury had an average decrease in standard daily doses (SDDs) at 12 months (À0.43; 95% CI: À0.63 to À0.23), and those without injury had a greater (p = 0.047) average decrease (À0.66; 95% CI: À0.78 to À0.55). Among nonusers at index, those with fall-related injury had a smaller increase than those without injury (+0.17, 95% CI: +0.13 to +0.21, vs. +0.24, 95% CI: +0.20 to +0.28, p = 0.005). Conclusions:The differences in CNS-active medication use change over 12 months between those with and without fall-related injury were small and unlikely to be clinically significant. These results suggest that fall riskincreasing drug use is not reduced following a fall-related injury, thus

Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study

“…Increased risk of fall injury associated with BZD use has been recognized for over 30 years [27,28], yet prescribing to older adults remains high [6], and BZD prescriptions are rarely changed even after a fall [29]. Prior analyses of the association between BZD regimen and risk of injury have focused on the risk of use versus non-use [19,20,30], but in the face of such persistent use, clinicians and patients may benefit from a more nuanced characterization of risk among those prescribed BZD.…”

“…The American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons recommends annual fall risk screening for adults ≥65 [33], while a recent review of fall prevention for community-dwelling older adults highlighted medication review as a key component of fall risk assessment [34]. Somewhat paradoxically, however, in clinical practice CNS-active medications are generally not being reduced after older adults experience fall injury [29]. Based on our analysis, first it is important for clinicians to recognize-and counsel patients appropriately-that older adults who receive a short-term BZD prescription are not necessarily at lower risk of fall injury.…”

Traumatic brain injury: Mechanisms, manifestations, and visual sequelae

“…Certain medications may increase the likelihood of falls among the elderly (Gillespie et al, 2012;Hopewell et al, 2018). Hart et al (2022) found that the dose of CNSactive medications, which include antidepressants, opioids, and benzodiazepines, was not reduced appreciably following a fallrelated injury in older adults. This suggests that adjustment in CNS-active medications is not being utilized adequately to modify fall risk.…”