The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center

Abstract

The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients. We conducted a retrospective analysis of PIM use in all geriatric patients evaluated at our Level 1 trauma center between 2014 and 2017. Patients were identified from our trauma database. Pre-admission medication use was determined through medication reconciliation from our electronic medical record (EMR). Patients not undergoing medication reconciliation were excluded. After initial analysis, patients were stratified by age into three groups: 65 to 74, 75 to 84, and ≥85 years. Multivariate logistic regression analyses were used to calculate odds ratios of falls for specific PIMs. In all, 2181 patients met the inclusion criteria. Overall, 71.2 per cent of geriatric trauma patients were prescribed at least one PIM—73.1 per cent of falls compared with 68.6 per cent for other mechanisms. Specific PIM use varied by age group. PIMs associated with fall risk in all patients included antipsychotics, benzodiazepines, and diclofenac. For those aged 65 to 74 years, antihistamines, diclofenac, proton pump inhibitors, and promethazine were associated. In those aged 75 to 84 years, alprazolam, antipsychotics, benzodiazepines, cyclobenzaprine, diclofenac, and muscle relaxants were implicated. No significant associations were found for patients aged ≥85 years. PIM use at our trauma center seems to be rampant and well above the national average. Geriatric falls were associated with using ≥1 PIM and multiple specific PIMs implicated. We are designing a targeted educational program for local primary care physicians (PCPs) that will attempt to decrease geriatric PIM use.

Potentially inappropriate prescribing and its associations with health‐related and system‐related outcomes in hospitalised older adults: A systematic review and meta‐analysis

“…Of these, 103 articles were excluded, mainly because studies reported a different outcome of interest ( n = 58). The final screening identified 63 studies 33–95 suitable for inclusion in this review (Figure 1).…”

“…Two studies 73,92 reported falls as an outcome. The prescription of Beers medications was significantly associated the incidence of falls 92 .…”

“…Two studies 73,92 reported falls as an outcome. The prescription of Beers medications was significantly associated the incidence of falls 92 . Similarly, the number of PIMs prescribed (according to STOPP for the Japanese version) was associated with increased occurrence of subsequent falls 1 year after hospital discharge 73 …”

“…These groups of medications have been associated with increased risk of falls. 92,101,102 Although only 2 studies, 73,92 in the current review, assessed the association between full PIM exposure and falls as a primary outcome, detecting a significant positive relationship; many of the included studies 42,44,51,52,74 demonstrated PIMs that increased fall-risk were largely responsible for medication-related hospital admissions. This is particularly important given that >2/3 of medication-related hospital admissions are likely to be preventable.…”

Inappropriate medications and physical function: a systematic review

“…Out of 30 studies, 21 showed a significant positive association between PIMs and risk of falls. 14 – 18 , 22 – 24 , 26 , 28 – 32 , 49 , 51 , 53 , 56 , 57 , 62 One study showed a positive predictive value of 25% for the proportion of patients with PPO-related admissions for a fall with a fracture. 56 Benzodiazepine, opiate and sedative use were common PIMs associated with falls.…”