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

• Published in: Journal of the American Geriatrics Society (JAGS) 2020-06, Vol.68 (6), p.1334-1343
• Main Authors: Hart, Laura A., Phelan, Elizabeth A., Yi, Julia Y., Marcum, Zachary A., Gray, Shelly L.
• Format: Article
• Language: English
• Subjects: Accidental Falls - statistics & numerical data; Aged; Antidepressants; Antidepressive Agents - adverse effects; Emergency medical care; Emergency Service, Hospital; Falls; fall‐related injury; Geriatrics; Health risks; Humans; Hypnotics; Hypnotics and Sedatives - adverse effects; Intervention; medications; Middle Aged; older adults; Older people; Pharmacy; Prevalence; Sedatives; Systematic review
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/jgs.16369

OBJECTIVES 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. DESIGN Systematic review. PARTICIPANTS Observational and intervention studies that assessed (or intervened on) FRID use in participants aged 60 years or older who had experienced a fall. MEASUREMENTS PubMed and EMBASE were searched through June 30, 2019. Two reviewers independently extracted data and evaluated studies for bias. Discrepancies were resolved by consensus. RESULTS 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. CONCLUSIONS 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.