EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Seppälä, Lotta J.; Velde, Nathalie van der; Masud, Tahir; Blain, Hubert; Petrovic, Mirko; Cammen, Tischa Jm van der; Szczerbińska, Katarzyna; Hartikainen, Sirpa; Kenny, Rose Anne; Ryg, Jesper; Eklund, Patrik; Topinková, Eva; Mair, Alpana; Laflamme, Lucie; Thaler, H; Bahat, Gülistan; Gutiérrez-Valencia, Marta; Mora, María Ángeles Caballero; Landi, Francesco; Emmelot-Vonk, Mariëlle H.; Cherubini, Antonio; Baeyens, Jean-Pierre; Correa-Pérez, Andrea; Guðmundsson, Adalsteinn; Marengoni, Alessandra; O’Mahony, Denis; Parekh, Nikesh; Pisa, Federica Edith; Rajkumar, Chakravarthi; Wehling, Martin; Ziere, Gijsbertus

doi:10.1007/s40266-018-0622-7

Cited by 39 publications

(38 citation statements)

References 53 publications

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“…(48) For this reason, asking patients about their history of falls should routinely be part of caring for patients with osteoporosis. (50)(51)(52) Fall risk may vary with the particular agent, however; thus, short-acting benzodiazepines and selective serotonin reuptake inhibitors may be safer in terms of fall risk than other drugs within their categories, (51) and the selectivity of beta-blockers may be a relevant factor. These include loop diuretics, antipsychotics, antidepressants, benzodiazepines, antiepileptics, and opioids.…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

“…These include loop diuretics, antipsychotics, antidepressants, benzodiazepines, antiepileptics, and opioids. (50)(51)(52) Fall risk may vary with the particular agent, however; thus, short-acting benzodiazepines and selective serotonin reuptake inhibitors may be safer in terms of fall risk than other drugs within their categories, (51) and the selectivity of beta-blockers may be a relevant factor. (50) Pharmacists can be helpful in reviewing FRID use Recommendation 1: Communicate three simple messages to people aged 65 years or older with a hip or vertebral fracture (as well as to their family/caregivers) consistently throughout the fracture care and healing process:…”

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

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Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

157

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Section: Fundamental Recommendations and Rationalesmentioning

confidence: 99%

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

157

View full text Add to dashboard Cite

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“…Falls are typically multifactorial and several drugs, named fall risk increasing drugs (FRID), can contribute to increase the probability of experiencing a fall. The European Geriatric Medicine Society working groups produced an explicit tool to identify FRID (STOPFALL) together with guidance to support an evidence-based approach in deprescribing these drugs [14] Among FRID, there are also antidepressants, which can contribute to increase the risk of falling with different mechanisms, including sedation, delirium, hyponatraemia, orthostatic hypotension, cardiac side effects and impaired mobility. On the other hand, depression has several negative consequences in older adults and increases the risk of falling.…”

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confidence: 99%

Mastering the complexity: drug therapy optimization in geriatric patients

2021

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“…The identification of increased risk of falls in different drug classes might be a crucial risk factor for falls. The European Geriatric Medicine Society and Finnish Expert Group on Fall-Risk-Increasing Drugs (FRIDs) have concluded that the knowledge about the risk of falls associated with therapeutic classes and individual medications can help in fall prevention [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units

et al. 2020

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Background Falls are common undesirable events for older adults in institutions. Even though the patient’s fall risk may be scored on admission, the medication-induced fall risk may be ignored. This study developed a preliminary categorization of fall-risk-increasing drugs (FRIDs) to be added as a risk factor to the existing fall risk assessment tool routinely used in geriatric care units. Methods Medication use data of older adults who had experienced at least one fall during a hospital ward or a nursing home stay within a 2-year study period were retrospectively collected from patient records. Medicines used were classified into three risk categories (high, moderate and none) according to the fall risk information in statutory summaries of product characteristics (SmPCs). The fall risk categorization incorporated the relative frequency of such adverse drug effects (ADEs) in SmPCs that were known to be connected to fall risk (sedation, orthostatic hypotension, syncope, dizziness, drowsiness, changes in blood pressure or impaired balance). Also, distribution of fall risk scores assessed on admission without considering medications was counted. Results The fall-experienced patients (n = 188, 128 from the hospital and 60 from nursing home records) used altogether 1748 medicaments, including 216 different active substances. Of the active substances, 102 (47%) were categorized as high risk (category A) for increasing fall risk. Fall-experienced patients (n = 188) received a mean of 3.8 category A medicines (n = 710), 53% (n = 375) of which affected the nervous and 40% (n = 281) the cardiovascular system. Without considering medication-related fall risk, 53% (n = 100) of the patients were scored having a high fall risk (3 or 4 risk scores). Conclusion It was possible to develop a preliminary categorization of FRIDs basing on their adverse drug effect profile in SmPCs and frequency of use in older patients who had experienced at least one documented fall in a geriatric care unit. Even though more than half of the fall-experienced study participants had high fall risk scores on admission, their fall risk might have been underestimated as use of high fall risk medicines was common, even concomitant use. Further studies are needed to develop the FRID categorization and assess its impact on fall risk.

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EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Cited by 39 publications

References 53 publications

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Mastering the complexity: drug therapy optimization in geriatric patients

Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units

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