Medication Use and Increased Risk of Falls in Hospitalized Elderly Patients

Rhalimi, Mounir; Hélou, Rafik; Jaecker, Pierre

doi:10.2165/11317610-000000000-00000

Cited by 65 publications

(41 citation statements)

References 17 publications

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“…A French retrospective case control study [26] reported that 50% of falls occurred in patients in their first week after hospital admission, with these classified as severe in 16% cases. The characteristics of the two groups under study (patients who fell and those who did not) were similar: there were no significant differences in variables such as age, sex, number of medicines or prevalence of hypertension or Parkinson's disease.…”

Section: Results With Discussionmentioning

confidence: 99%

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

Tanna¹,

Tatla²,

Winn³

et al. 2016

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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.

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Section: Results With Discussionmentioning

confidence: 99%

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

Tanna¹,

Tatla²,

Winn³

et al. 2016

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“…8,16,17,[27][28][29][30][42][43][44][45][46][47][48] Medications including benzodiazepines, anticonvulsants, antihypertensives, antidepressants, and sleep aids have also been targeted as high-risk medications. 8,[26][27][28][31][32][33][34][35]42,[49][50][51][52][53][54][55][56] Two additional risk factors that are often mentioned are male sex and poor functioning or inability to independently perform activities of daily living. 13,15,19,24,27,35,56,57 …”

Section: Risk Stratificationmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

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“…[1][2][3][4][5][6][7][8][9] Complications associated with falls among hospitalized patients can result in death, disability, increased hospital length of stay, placement in an extended care facility, psychological distress, and litigation. 1,4,[10][11][12][13] In addition, the cost of falls in the United States may be more than $40 billion by 2020.…”

mentioning

confidence: 99%

“…1,12,[18][19][20][21][22][23][26][27][28][29][30][31][32][33][34] Yet, falls continue to be a serious safety threat, especially for acutely ill, hospitalized patients. 2,[5][6][7][8]16,17,19,20,30,31 Nurses routinely assess hospitalized patients' risk for falls and educate patients on preventing falls. However, strategies to reduce falls have limited effectiveness if patients do not follow the fall-prevention plans.…”

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confidence: 99%

Perceptions Related to Falls and Fall Prevention Among Hospitalized Adults

Twibell

Siela

Sproat

et al. 2015

American Journal of Critical Care

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Background Prevention of falls during hospitalization depends in part on the behaviors of alert patients to prevent falls. Research on acutely ill patients’ intentions to behave in ways that help prevent falls and on the patients’ perceptions related to falls is limited. Objective To explore hospitalized adults’ perceptions related to risk for falling, fear of falling, expectations of outcomes of falling, and intention to engage in behaviors to prevent falls. Methods Adult, alert, acutely ill inpatients (N = 158) at risk for falling completed a survey consisting of 4 scales and 3 single items. Nurses’ assessments and patients’ perceptions of the risk for falling were compared. Results Decreased intentions to engage in behaviors to prevent falls were correlated with patients’ increased confidence in their ability to perform high-risk behaviors without help and without falling (P < .001), decreased fear of falling (P < .001), and decreased perceived likelihood of adverse outcomes if they did fall (P < .001). Although nurses’ assessments indicated a risk for falls, 55.1% of the patients did not perceive a high likelihood of falling while hospitalized. Whereas 75% of patients intended to ask for help before getting out of bed, 48% were confident that they could get out of bed without help and without falling. Conclusions Although assessments may indicate a risk for falling, acutely ill inpatients may not perceive they are likely to fall. Patients’ intentions to engage in behaviors to prevent falls vary with the patients’ fall-related perceptions of confidence, outcomes, and fear related to falling.

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Medication Use and Increased Risk of Falls in Hospitalized Elderly Patients

Abstract: Some drugs are associated with an increased risk of falls in the elderly and, when alternatives exist, should be avoided until cohort studies are conducted to confirm or refute these possible increased risks.

Cited by 65 publications

References 17 publications

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

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

Inpatient Falls

Perceptions Related to Falls and Fall Prevention Among Hospitalized Adults

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