Background: Falls are the leading cause of unintentional injuries and injury-related deaths among adults aged 65 years and older. FRIDs (such as antidepressants, sedatives-hypnotics, and opioids) continue to be a major contributor for risk of falls. At the same time, little is known about prevalence of use or interventions directed toward reduction of use in older adults presenting with fall.
Dr. Yarra Pradeep
Study design: Systematic review.
Setting: PubMed and Embase databases were used to search for studies published in English on or before June 30, 2019. Search terms included older adults, falls, medication classes, and hospitalizations among other related terms.
Synopsis: The review included a total of 14 articles (10 observational studies and 4 prospective intervention studies). High prevalence of FRID use (65%-93%) was seen in older adults with fall-related injury. Use of FRIDs continued to remain high at 1 month and 6 months follow-up after a fall. Antidepressants, sedative-hypnotics, opioids, and antipsychotics were the most commonly used FRIDs. Three randomized controlled trials showed no effect of reducing FRID use on reduction in falls. An outpatient clinic pre-post assessment study based on intervention by geriatrician and communication with prescribing physicians led to reduction in FRID use and falls.
Limitations of this review included high risk of bias in observational studies and unclear timeline definitions of interventions or outcome measurements in the intervention studies. In conclusion, there is a significant need for well-designed interventions targeted at reducing FRID use in conjunction with other risk factors to decrease the incidence of falls comprehensively. An aggressive approach directed toward patient education along with primary care communication may be the key to reducing FRID use in this population.
Bottom line: With limited evidence, there is a high prevalence of FRID use in older adults presenting with falls and no reduction in FRID use following the encounter.
Citation: Hart LA et al. Use of fall risk-increasing drugs around a fall-related injury in older adults: A systematic review. J Am Geriatr Soc. 2020 Feb 17. doi: 10.1111/jgs.16369.
Dr. Yarra is a hospitalist and assistant professor of medicine at UK HealthCare, Lexington, Ky.