Management of fall-risk-increasing drugs in Australian aged care residents: a retrospective cross-sectional study.

Abstract

Background: Globally, falls are considered a serious healthcare problem for aged care residents. Fall-risk-increasing drugs (FRIDs) are medications that can increase the risk of falling, given their adverse effects. Medication reviews are advocated to identify potentially inappropriate use of FRIDs. However, their impact on clinical and resident-centered outcomes is unclear. This study explored aged care residents' use of FRIDs and the content of medication review reports concerning these.

Methods: A retrospective cross-sectional study of medication review reports completed between 1st July 2021 and 30th June 2022 was conducted. Statistical descriptive analysis was used to examine the use of FRIDs (defined as medications listed in the Screening Tool of Older Persons Prescriptions in older adults with high fall risk (STOPPFall)). The resident's medicine experience, identified drug-related problems (DRPs), and related recommendations concerning FRIDs were explored via content analysis. For recommendations to deprescribe FRIDs, clinical situations detailed in the reports were compared to those presented in STOPPFall.

Results: Medication review reports relating to 966 residents were analysed. Of these residents, 83.2% (n = 804) used FRIDs, with 31.2% (n = 301) taking three or more FRIDs. In total, pharmacists made recommendations concerning 2635 identified DRPs, of which 19.7% (n = 520) were the potentially inappropriate use of FRIDs and deprescribing was recommended. The clinical situation for which deprescribing was most frequently recommended was the use of a FRID for an indication of limited clinical benefit 37.9% (n = 197). The clinical situation was not detailed for 130 (25.0%) recommendations to deprescribe FRIDs, and only three reports included the resident's viewpoint on deprescribing.

Conclusions: FRID use was found to be highly prevalent among aged care residents. Pharmacists frequently identified opportunities to deprescribe FRIDs. However, reports often omitted resident viewpoints and the clinical grounds for deprescribing. Using resident-centered communication in medication review reports could improve their impact on FRID use and resident outcomes.