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

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

Methods: 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.

Key findings: 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.

Conclusion: 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.
FRID, deprescribing, fall, fracture, older people
0961-7671
Cox, Natalie
ee547627-9048-46fe-ad0e-56846528f9b5
Ilyas, Isra
6c9bd423-8e3f-439d-b907-39c2d9d37e0e
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Ibrahim, Kinda
54f027ad-0599-4dd4-bdbf-b9307841a294
Cox, Natalie
ee547627-9048-46fe-ad0e-56846528f9b5
Ilyas, Isra
6c9bd423-8e3f-439d-b907-39c2d9d37e0e
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Ibrahim, Kinda
54f027ad-0599-4dd4-bdbf-b9307841a294

Cox, Natalie, Ilyas, Isra, Roberts, Helen and Ibrahim, Kinda (2022) Exploring the prevalence and types of fall-risk-increasing drugs among older people with upper limb fractures. International Journal of Pharmacy Practice, [riac084]. (doi:10.1093/ijpp/riac084).

Record type: Article

Abstract

Objectives: 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.

Methods: 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.

Key findings: 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.

Conclusion: 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.

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More information

Accepted/In Press date: 13 October 2022
e-pub ahead of print date: 10 November 2022
Keywords: FRID, deprescribing, fall, fracture, older people

Identifiers

Local EPrints ID: 472293
URI: http://eprints.soton.ac.uk/id/eprint/472293
ISSN: 0961-7671
PURE UUID: 0abff49d-1ecd-4ace-b5a2-1107d926dfa8
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880
ORCID for Kinda Ibrahim: ORCID iD orcid.org/0000-0001-5709-3867

Catalogue record

Date deposited: 30 Nov 2022 17:49
Last modified: 02 Dec 2022 02:46

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Contributors

Author: Natalie Cox
Author: Isra Ilyas
Author: Helen Roberts ORCID iD
Author: Kinda Ibrahim ORCID iD

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