A study to evaluate the potential contribution of medication use to falls in elderly patients presenting to an acute hospital

Introduction: Falls in elderly patients is a growing burden on healthcare resources globally. 10-15% of presentations in those ≥65 years at acute hospital services is due to falls. Medicines and polypharmacy are modifiable risk factors for falls. Different classes of medicines increase the risk of falling to differing extents. Aims: The aim was to review the role of medicines in falls in elderly at Our Lady of Lourdes Hospital Drogheda (OLOL). The objectives were: 1: Examine polypharmacy. 2: Examine the implication of the top five classes of falls risk increasing drugs (FRIDs) as potential causative factors in falls. 3: Determine is there a difference in medicine profile between those residing at home and in Long Term Care Facilities (LTCFs). 4: Has the Clinical Pharmacist a role in reducing patients’ risk of future falls. Methods: Admission records in OLOL were checked daily for elderly patients admitted due to a fall. When consent was granted data was collected from their records. Results: 94 patients met the inclusion criteria. 53 were recruited, 41 were excluded. Only 1 LTCF resident was recruited for the study, therefore objective 3 could not be examined. The Falls Risk Odds Ratio (FROR) was reduced for benzodiazepines, ACEi’s, ARB’s and diuretics but it was not a statistically significant reduction in FROR (p=0.22). Polypharmacy: Patients on ≥ 5 medicines on admission (41) 77%; Patients on ≥ 5 medicines on review (44) 83%; Polypharmacy by Medicine Class : Antipsychotics 100%; Benzodiazepines 100% ; Sedatives 100% Antidepressants 94%; Antihypertensives 76%. No of patients on ≥1 FRID: 94.3%. FRID prescribing by class: Antihypertensives 79.2%; Antidepressants 30.2%; Benzodiazepines 13.2%; Sedatives 11.3% ; Antipsychotics 1.9%. Clinical Pharmacist Recommendations Actioned Overall 41.7%. Actioned per FRID class: Antihypertensives 57.9%; Benzodiazepines 28.7%. Conclusions: Pharmacists have a role to play in highlighting polypharmacy and the prescribing of FRIDs.