Clinical Medication Review and Falls in Older People—What Is the Evidence Base?

Abstract

Background: This paper reports findings from a literature review undertaken to assess the current evidence base for clinical medication review and falls in older people. This forms part of a larger, organisational supported project design work-stream, where the objectives are to define the operational details for clinical medication review as part of multi-factorial assessment for elderly fallers in the community. Patients will be identified and targeted through an integrated care pathway mapping and elderly patient care screening service. Objective: A review of national and best practice guidance to help our understanding of how clinical medication review could be optimised. Methods: A PubMed database search was undertaken with search terms including "elderly" and "falls" and "medicines" followed by study of relevant publications in English and including cited referenced publications within selected papers. Results: Our findings were that both medication over-use and under-use in the elderly occur frequently and can be harmful. Many drugs commonly used by older persons have not been systematically studied as risk factors for falls. The screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START), validated for assessment of potentially inappropriate prescribing in the elderly, offer the possibility of provision of a structured clinical medication review to patients, with a need for more research on the impact of the STOPP START interventions on both the rates of falls and risk of falls in the elderly.

The relation between falls and medication use among elderly in assisted living facilities

“…These results were consistent with previous literatures linking the use of cardiovascular or psychotropic drugs to the risk of falls, with special concern about antipsychotics, sedative‐hypnotics, vasodilators, alpha blockers, and opioids …”

Pharmacological options for pain control in patients with vertebral fragility fractures

“…This is because chronic pain has an unpredictable nonlinear trajectory complicated by the patient's mood, perception of pain, experience, circumstances, and fear [ 57 ]. Significant side effects, associated with opioid use, include cardiorespiratory depression, gastrointestinal disturbance, cognitive impairment and increase in risk of falls [ [58] , [59] , [60] ]. Tanna et al [ 59 ] highlighted polypharmacy and falls risks with combined use of opioids and sedative drugs, antidepressants, muscle relaxants, and anticholinergics, with the recommendation that these patients would benefit from regular medicines deprescribing and optimization reviews [ 28 ].…”