Prescribing patterns of fall risk-increasing drugs in older adults hospitalized for heart failure.

Older adults hospitalized for heart failure (HF) are at risk for falls after discharge. One modifiable contributor to falls is fall risk-increasing drugs (FRIDs). However, the prevalence of FRIDs among older adults hospitalized for HF is unknown. We describe patterns of FRIDs use and examine predictors of a high FRID burden. We used the national biracial REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort recruited from 2003-2007. We included REGARDS participants aged ≥ 65 years discharged alive after a HF hospitalization from 2003-2017. We determined FRIDs -cardiovascular (CV) and non-cardiovascular (non-CV) medications - at admission and discharge from chart abstraction of HF hospitalizations. We examined the predictors of a high FRID burden at discharge via modified Poisson regression with robust standard errors. Among 1147 participants (46.5% women, mean age 77.6 years) hospitalized at 676 hospitals, 94% were taking at least 1 FRID at admission and 99% were prescribed at least 1 FRID at discharge. The prevalence of CV FRIDs was 92% at admission and 98% at discharge, and the prevalence of non-CV FRIDs was 32% at admission and discharge. The most common CV FRID at admission (88%) and discharge (93%) were antihypertensives; the most common agents were beta blockers (61% at admission, 75% at discharge), angiotensin-converting enzyme inhibitors (36% vs. 42%), and calcium channel blockers (32% vs. 28%). Loop diuretics had the greatest change in prevalence (53% vs. 72%). More than half of the cohort (54%) had a high FRID burden (Agency for Healthcare Research and Quality (AHRQ) score ≥ 6), indicating high falls risk after discharge. In a multivariable Poisson regression analysis, the factors strongly associated with a high FRID burden at discharge included hypertension (PR: 1.41, 95% CI: 1.20, 1.65), mood disorder (PR: 1.24, 95% CI: 1.10, 1.38), and hyperpolypharmacy (PR: 1.88, 95% CI: 1.64, 2.14). FRID use was nearly universal among older adults hospitalized for HF; more than half had a high FRID burden at discharge. Further work is needed to guide the management of a common clinical conundrum whereby guideline indications for treating HF may contribute to an increased risk for falls.

Liu E ，Nahid M ，Musse M ，Chen L ，Hilmer SN ，Zullo A ，Kwak MJ ，Lachs M ，Levitan EB ，Safford MM ，Goyal P ... -  《BMC Cardiovascular Disorders》

Factors associated with fall risk increasing drug use in older black and white men and women: the Health ABC Study.

Roberts JE ，Boudreau RM ，Freeland KS ，Xue L ，Ruppert KM ，Buchanich JM ，Pruskowski JA ，Cauley JA ，Strotmeyer ES ... -  《BMC Geriatrics》

Exploring the prevalence and types of fall-risk-increasing drugs among older people with upper limb fractures.

Medications and specifically fall-risk-increasing drugs (FRIDs) are associated with increased risk of falls: reducing their prescription may improve this risk. This study explored patient characteristics associated with FRID use, prevalence and type of FRIDs and changes in their prescriptions among older people with arm fractures over 6 months. Observational prospective study in three fracture clinics in England. Patients aged ≥65 years with a single upper limb fragility fracture were recruited. The STOPPFall tool identified the number and type of FRIDs prescribed at baseline, 3- and 6-month follow-ups. Changes in FRID prescription were categorised as discontinued, new or exchanged. 100 patients (median age 73 years; 80% female) were recruited. At baseline, 73% used ≥1 FRID daily (median = 2), reducing to 64% and 59% at 3 and 6 months, respectively. Those with >1 FRID prescription had a significantly higher number of co-morbidities and medications and higher rates of male gender, polypharmacy, frailty and sarcopenia. The most frequently prescribed FRIDs were antihypertensives, opioids and antidepressants. Between 0 and 3 months, 44 (60%) participants had changes to FRID prescription: 20 discontinued (opioids and antihistamines), 13 started (antidepressants) and 11 exchanged for another. Similar trends were observed at 6 months. Use of FRIDs among older people with upper limb fragility fractures was high. Although overall use decreased over time, 59% were still on ≥1 FRID at the 6-month follow-up, with trends to stop opioids and start antidepressants. Older people presenting with upper limb fractures should be offered a structured medication review to identify FRIDs for targeted deprescribing.

Cox N ，Ilyas I ，Roberts HC ，Ibrahim K ... -  《-》

Use of Fall Risk-Increasing Drugs Around a Fall-Related Injury in Older Adults: A Systematic Review.

To examine: (1) prevalence of fall risk-increasing drug (FRID) use among older adults with a fall-related injury, (2) which FRIDs were most frequently prescribed, (3) whether FRID use was reduced following the fall-related healthcare episode, and (4) which interventions have reduced falls or FRID use in older adults with a history of falls. Systematic review. Observational and intervention studies that assessed (or intervened on) FRID use in participants aged 60 years or older who had experienced a fall. PubMed and EMBASE were searched through June 30, 2019. Two reviewers independently extracted data and evaluated studies for bias. Discrepancies were resolved by consensus. Fourteen of 638 articles met selection criteria: 10 observational studies and 4 intervention studies. FRID use prevalence at time of fall-related injury ranged from 65% to 93%. Antidepressants and sedatives-hypnotics were the most commonly prescribed FRIDs. Of the 10 observational studies, only 2 used a design adequate to capture changes in FRID use after a fall-related injury, neither finding a reduction in FRID use. Three randomized controlled studies conducted in various settings (hospital, emergency department, and community pharmacy) with 12-month follow-up did not find a reduction in falls with interventions to reduce FRID use, although the study conducted in the community pharmacy setting was effective in reducing FRID use. In a nonrandomized (pre-post) intervention study conducted in an outpatient geriatrics clinic, falls were reduced in the intervention group. Limited evidence indicates high prevalence of FRID use among older adults who have experienced a fall-related injury and no reduction in overall FRID use following the fall-related healthcare encounter. There is a need for well-designed interventions to reduce FRID use and falls in older adults with a history of falls. Reducing FRID use as a stand-alone intervention may not be effective in reducing recurrent falls. J Am Geriatr Soc 68:1334-1343, 2020.

Hart LA ，Phelan EA ，Yi JY ，Marcum ZA ，Gray SL ... -  《-》

Study of fall risk-increasing drugs in elderly patients before and after a bone fracture.

Accidental falls have a significant economic and human impact. The use of certain drugs is one of the modifiable risk factors associated with these events. The aim of this study was to determine the prevalence of use and to explore changes in treatment with fall-related drugs in patients over 65 years of age admitted as a result of a fall-related fracture. Observational and prospective study performed in a tertiary level hospital. A list of fall risk-increasing drugs (FRIDs) was drawn up. The main study variables were number and type of FRIDs prescribed at admission and 1 month after the fracture and number, type, treating physician and place where changes in FRIDs were implemented. In total, 252 patients were included. At admission, 91.3% were receiving at least one FRID, mean daily use was 3.1 FRIDs and the most frequently prescribed FRIDs were diuretics (18%), renin-angiotensin system-acting agents (15.8%) and antidepressants (15%). One month later, mean daily use was 3.4 FRIDs (p=0.099) and a significant increase was detected in the use of hypnotics (p=0.003) and antidepressants (p=0.042). A total of 327 changes in treatment were recorded (1.3 changes/patient). Of the changes, 52.6% were new prescriptions, 72.2% occurred at discharge and 56.6% were ordered by a geriatrician. The use of FRIDs among patients with a fall-related fracture is very high. This use rises 1 month after the fracture, significantly in the case of hypnotics and antidepressants.

Beunza-Sola M ，Hidalgo-Ovejero ÁM ，Martí-Ayerdi J ，Sánchez-Hernández JG ，Menéndez-García M ，García-Mata S ... -  《-》