Pharmacotherapy as major risk factor of falls - analysis of 12 months experience in hospitals in South Bohemia

Abstract

This study aimed to analyze the effect of fall risk-increasing drugs (FRIDs) and drug-related factors relative to falls through clinical pharmacy service in hospitalized patients, focusing on the relevance of clinical pharmacist evaluation in the context of physician assessment. A prospective study of inpatient falls was conducted in 2017 retrieving data from 4 hospitals in South Bohemia, Czech Republic. An online database was developed to collect patient and fall-related data, and fall evaluation records. Healthcare professionals classified the overall effect of drugs on falls using Likert scale. Univariate and multivariate correlations were performed with a significance level of p < 0.05. Out of the total 280 falls (mean age of patients 77.0 years), a mean of 2.8 diagnoses with fall-related risk, 8.8 drugs, and 4.1 FRIDs per fall were identified. Incidence of falls decreased quarterly (p < 0.001). Use of FRIDs were positively associated with increasing age (p = 0.007). Clinical pharmacists were more likely to identify pharmacotherapy as the relevant fall-related risk, compared to physicians evaluation (p < 0.001). An increasing total number of prescribed drugs as well as higher number of FRIDs increased the suspicion in both professionals in the context of drug-related causes of falls.

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

“…According to our findings, the fall risk assessment tool presented in this study could be helpful to prevent medication-related falls and increase quality of geriatric care in health care institutions. This is supported by the findings of previous studies that have reported the medication use as a remarkable but modifiable fall risk factor [ 48 , 50 ]. Therefore, it is reasonable to implement a strategy to avoid use of fall risk-increasing drugs in the routine practice in geriatric care units.…”

“…The increased fall risk is also evidenced in patients using opioids (OR = 1.61), antiepileptics (OR = 1.55), anti-Parkinson drugs (OR = 1.54), and NSAIDs (OR = 1.09) [ 46 , 47 ]. Furthermore, the previous study from Czech Republic (Maly et al [ 48 ]) classified drugs that affected to the nervous system (antipsychotics, antidepressants, analgesics) and to the cardiovascular system (diuretics, beta blocking agents, agents acting on the renin-angiotensin system) as the most frequently used fall risk-increasing drugs in hospitals. Thus, many studies have reached similar conclusions, although the fall-increasing medicines have been presented slightly in different order.…”

Falls in hospitalized older adults and the use of fall risk-increasing drugs and anticholinergic medications in Colombia: a case‒control study

“…This association between the use of potentially inappropriate medications and falls in older adults is stronger in the presence of more comorbidities, which results in the prescription of more medications ( Johnell and Fastbom, 2008 ) and increases the probability of pharmacologic interactions and other problems related to medications. A correct pharmacotherapeutic evaluation of a hospitalized patient, especially a patient aged ≥65 years and with polypharmacy, can identify inappropriate or risky prescriptions and can reveal the probability of suffering a fall and the potential need to avoid particular higher-risk medications ( Maly et al, 2019 ).…”