Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial

Abstract

Netherlands Trial Register NTR1593.

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

“…The STRIDE study and other current fall prevention protocols have attempted to address this need; however, they are not initiated in the ED immediately after a fall when patients and caregivers are highly engaged in care and fall prevention . A multicenter randomized trial in the Netherlands that recruited older adults within 2.5 months of an ED visit for a fall did not show a reduction in recurrent falls by targeting the cessation of fall‐risk increasing medication . This trial had to prolong its recruitment window from 2 to 4 years to recruit its desired sample size of 620 individuals, likely in part because the investigators required patients to follow up at their outpatient research clinic and be available for another in‐person follow‐up 1 year later .…”

Falls-Related Drug Use and Risk of Falls Among Older Adults: A Study in a US Medicare Population

“…Although research studies have associated these selected falls-related drugs (FRDs) with the risk of falls, there is no comprehensive, evidence-based list of specific problematic medications in general use. European researchers use a list of fall-risk increasing drugs [6–13]; the US Veterans Administration has used a list from the Canadian Safety Council [14, 15]; other US researchers have utilized an augmented list recommended by Woolcott et al [16–18]; and others have created FRD lists from various published research studies [19]. …”

“…Interventions to address the risk of falls associated with FRDs have primarily focused on medication reviews by nurses, pharmacists, research physicians, or hospital physicians [7–10, 13, 18, 26, 27]. These programs attempt to reduce the number of FRD prescriptions by withdrawing patients completely from selected FRDs, or at least reducing doses.…”

“…reducing prescriptions and/or falls) in small-scale research studies, most attempts have generally concluded that deprescribing drugs for older adults has proven difficult. In one recent intervention focused on patients with injurious falls, 40% of study patients could not have their drug regimens altered, and another 35% refused to change for a variety of reasons [13]. Furthermore, among those who changed by reducing FRDs, 47% resumed the drugs 6 months after the intervention concluded [27].…”

Avoiding anchoring bias by moving beyond ‘mechanical falls’ in geriatric emergency medicine

“…Less intense ED fall prevention interventions such as educating patients with pamphlets or educating staff regarding guidelines did not reduce falls or injuries, but did transiently improve other outcomes . Other simple interventions like stopping medications associated with falls have not reduced subsequent falls . Acknowledging ED time, space, and personnel constraints, the primary focus after injury management for older fallers being discharged home should be to initiate the process of screening fall risk with immediate interventions for amenable risk factors (de‐prescribing high‐risk medications) and referral to the general practitioner for more detailed assessment and management.…”