Article Text

other Versions

PDF
Deprescribing medicines in the acute setting to reduce the risk of falls
  1. Vanessa Marvin1,
  2. Emily Ward1,
  3. Alan J Poots2,
  4. Katie Heard1,
  5. Arvind Rajagopalan3,
  6. Barry Jubraj2,4
  1. 1Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2NIHR CLAHRC NWL, Imperial College London, London, UK
  3. 3School of Medicine, Imperial College London, London, UK
  4. 4Institute of Pharmaceutical Sciences, King's College London, London, UK
  1. Correspondence to Dr Vanessa Marvin, Department of Pharmacy, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; vanessa.marvin{at}chelwest.nhs.uk

Abstract

Background Falls are a common cause of morbidity and hospitalisation in older people. Inappropriate prescribing and polypharmacy contribute to falls risk in elderly patients. This study's aim was to quantify the problem and find out if medication review in the hospital setting led to deprescribing of medicines associated with falls risk.

Methods Admissions records for elderly patients were examined to identify those whose presenting complaint included a fall. Inpatient medication charts, pharmaceutical care notes, medical notes and discharge summaries were examined to identify any falls-risk medicines from admission histories and to determine if any medication review took place, and whether or not changes were made as a result. In particular deprescribing and dose reduction details were analysed.

Results 100 patients over 70 years old were admitted following a fall during the 2 months study period. The mean number of medicines on admission was 6.8 per patient with polypharmacy found in 62/100 (62%). One or more falls-risk medicine was found in 65/100 (65%) patients. Medicines review was carried out in 86/100 (86%) of patients, and 59/697 (8.5%) medicines were deprescribed. Pharmacist involvement in medication review led to a significant reduction in the number of falls-risk medicines per patient (p=0.002).

Conclusions Inappropriate prescribing and polypharmacy are found frequently in elderly patients at admission following a fall. Comprehensive medicines reviews should be carried out in all such patients with the objective of deprescribing or reducing doses to minimise risk of harm. Involvement of a pharmacist improves the rate of reduction of falls-risk medicines.

  • Falls
  • quality improvement
  • deprescribing
  • CLINICAL PHARMACY
  • medication review
  • hospital

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial
    Nina Barnett Barry Jubraj