The potential contribution of medicines to falls in older persons and the acceptance of pharmacist intervention

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Richardson, M.
O'Dwyer, C.
Gaskin, J.
Conyard, E.
Murphy, Kevin D.
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Introduction: Falls in older patients (≥65 years) is a growing burden on healthcare resources globally. Falls in older persons are responsible for 10–15% of presentations to acute hospitals and are the cause of > 50% of injury‐related hospitalisations in older persons1. Medicines are a modifiable risk factor for falls and the risk varies by class of medicine. Common medicine classes classified as Falls Risk Increasing Drugs (FRIDs) include antihypertensive agents, benzodiazepines, antidepressants, and neuroleptics2. The consequences of a fall can persist after discharge; patients have reported a reduction in quality of life up to 9 months after a fall and the fear of further falls has been associated with decreased physical activity. Aim: The aim of this study was to examine FRID use in older persons presenting with falls at Our Lady of Lourdes Hospital Drogheda (OLOL) in the Republic of Ireland, and the acceptance of a clinical pharmacist (CP) intervention in reducing FRIDs in this cohort. Methods: The study was conducted over a 6‐week period between June 1st and July 13th 2018 at OLOL in the Republic of Ireland. Consent was sought from patients who were ≥ 65 years, presented to the hospital with an acute fall or with injuries sustained due to an acute fall. Data collection involved patient demographics, admission details, reconciled medication list, and relevant patient observations and laboratory results. The CP provided written or oral medicines’ recommendations to physicians, and patient file was examined between July 16th and 20th to review uptake of the CP recommendations. Analysis was in the form of the extent of implementation of CP recommendations and review of polypharmacy. Results: There were 53 patients who took part in the study. There were slightly more females (52.8%) and the mean age was 81 ± 6.7 years. Most patients had had a previous fall (66.0%), with the majority having > 5 previous falls (52.8%). Fractures were reported by 39.6% with hip fractures being the most common type of fracture (11/53, 20.8%). The median number of medicines was 7 (IQR: 5–10.25). The median number of FRIDs was 2 (IQR: 1–3), with antihypertensives accounting for 73.0% (92/126) of FRIDs. The CP made 36 recommendations regarding 26 patients. Less than half (41.7%) of the CP recommendations were implemented. The most common drug classes with recommendations implemented were antihypertensives (19) and benzodiazepines (7). These were also the classes with the highest acceptance rate, with 57.9% of recommendations regarding antihypertensives (11/19) being accepted and 71.4% of recommendations for benzodiazepines being accepted (5/7). Conclusions: CPs have a role to play in highlighting the prescribing of FRIDs and in the reduction of the number of FRIDs taken by older persons with a history of falls. Reducing the number of falls will help older patients maintain their quality of life and reduce the number of acute hospital admissions in a stretched healthcare system.
Older patients , Falls Risk Increasing Drugs (FRIDs) , Fallss , Intervention , Clinical pharmacist , Quality of life
Richardson, M., O’Dwyer, C., Gaskin, J., Conyard, E. and Murphy, K. D. (2020) ‘The potential contribution of medicines to falls in older persons and the acceptance of pharmacist intervention’, Health Services Research and Pharmacy Practice Conference, Cardiff, Wales, 16-17 April, in International Journal of Pharmacy Practice, 28 (S1), pp. 57-58. doi: 10.1111/ijpp.12607
©The Authors. IJPP © 2020 Royal Pharmaceutical Society