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Interventions to Reduce Fall-Risk-Increasing Drug Use to Prevent Falls: A Narrative Review of Randomized Trials

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Abstract

Background

Falls and fall-related injuries are of growing concern among older adults. Use of fall-risk-increasing drugs (FRIDs) is a potentially modifiable risk factor. This narrative review describes randomized controlled trials that focused on interventions to reduce FRID use and examined fall-related outcomes (e.g., falls, fractures, risk of injury) as the primary outcome.

Methods

A comprehensive literature search was conducted to identify eligible studies. Two reviewers screened titles and abstracts and then performed a full-text review of relevant articles. Each study is summarized, and a discussion of strengths and limitations is provided.

Results

7 of 22 trials were included in this narrative review. Two studies used a computerized decision support intervention, three used a health professional-led (pharmacist or geriatrician) intervention, and two were direct medication withdrawal interventions. Three studies showed a reduction in fall-related outcomes (two identified fall injuries using claims data; one used an injury risk prediction score). Of these, only one reported FRID reduction. Of four studies that did not find a reduction in falls, one study reported a significant reduction in FRIDs, two found no reduction, and one did not report on this outcome. Most interventions consisted of a one-time FRID assessment, and most targeted either providers or patients (not both).

Conclusion

Most interventions did not reduce FRID use or change fall-related outcomes. Future studies should test “multi-pronged” intervention strategies that simultaneously target both patients and their providers and include more than a single intervention interaction to reduce this modifiable fall risk factor.

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References

  1. Hartholt KA, Stevens JA, Polinder S, Van Der Cammen TJM, Patka P. Increase in fall-related hospitalizations in the United States, 2001–2008. J Trauma. 2011;71(1):255–8.

    PubMed  Google Scholar 

  2. Hill K, Schwarz J, Flicker L, Carroll S. Falls among healthy, community-dwelling, older women: A prospective study of frequency, circumstances, consequences and prediction accuracy. Aust N Z J Public Health. 1999;23(1):41–8.

    Article  CAS  Google Scholar 

  3. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.

    Article  CAS  Google Scholar 

  4. Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health. 1992;13:489–508.

    Article  CAS  Google Scholar 

  5. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693–8.

    Article  Google Scholar 

  6. Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med. 1997;337(18):1279–84.

    Article  CAS  Google Scholar 

  7. Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci. 1998;53(2):M112–9.

    Article  CAS  Google Scholar 

  8. Phelan EA, Rillamas-Sun E, Johnson L, Lamonte MJ, Buchner DM, Lacroix AZ, et al. Determinants, circumstances and consequences of injurious falls among older women living in the community. Inj Prev. 2020. https://doi.org/10.1136/injuryprev-2019-043499.

    Article  PubMed  Google Scholar 

  9. Seppala LJ, Wermelink A, de Vries M, Ploegmakers KJ, van de Glind EMM, Daams JG, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics. J Am Med Dir Assoc. 2018;19(4):371.e11-371.e17.

    Article  Google Scholar 

  10. de Vries M, Seppala LJ, Daams JG, van de Glind EMM, Masud T, van der Velde N. Fall-risk-increasing drugs: a systematic review and meta-analysis: I. Cardiovascular drugs. J Am Med Dir Assoc. 2018;19(4):371.e1–371.e9.

  11. Haddad YK, Luo F, Karani MV, Marcum ZA, Lee R. Psychoactive medication use among older community-dwelling Americans. J Am Pharm Assoc (2003). 2019;59(5):686–90.

  12. Moxey ED, O’Connor JP, Novielli KD, Teutsch S, Nash DB. Prescription drug use in the elderly: a descriptive analysis. Health Care Financ Rev. 2003;24(4):127–41.

    PubMed  PubMed Central  Google Scholar 

  13. Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018;9(9):CD005465.

  14. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;(9):CD007146.

  15. Dills H, Shah K, Messinger-Rapport B, Bradford K, Syed Q. Deprescribing medications for chronic diseases management in primary care settings: a systematic review of randomized controlled trials. J Am Med Dir Assoc. 2018;19(11):923-935.e2.

    Article  Google Scholar 

  16. Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2018;7(7):CD012221.

  17. Kua CH, Mak VSL, Huey Lee SW. Health outcomes of deprescribing interventions among older residents in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20(3):362-372.e11.

    Article  Google Scholar 

  18. Thillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials. Drugs Aging. 2018;35(4):303–19.

    Article  CAS  Google Scholar 

  19. Lapane KL, Hughes CM, Daiello LA, Cameron KA, Feinberg J. Effect of a pharmacist-led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes. J Am Geriatr Soc. 2011;59(7):1238–45.

    Article  Google Scholar 

  20. Tamblyn R, Eguale T, Buckeridge DL, Huang A, Hanley J, Reidel K, et al. The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial. J Am Med Inform Assoc. 2012;19(4):635–43.

    Article  Google Scholar 

  21. Blalock SJ, Casteel C, Roth MT, Ferreri S, Demby KB, Shankar V. Impact of enhanced pharmacologic care on the prevention of falls: a randomized controlled trial. Am J Geriatr Pharmacother. 2010;8(5):428–40.

    Article  CAS  Google Scholar 

  22. Blalock SJ, Ferreri SP, Renfro CP, Robinson JM, Farley JF, Ray N, et al. Impact of STEADI-Rx: a community pharmacy-based fall prevention intervention. J Am Geriatr Soc. 2020;68(8):1778–86.

    Article  Google Scholar 

  23. Weber V, White A, Mcllvried R. An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population. J Gen Intern Med. 2008;23(4):399–404.

  24. Boyé NDA, van der Velde N, de Vries OJ, van Lieshout EMM, Hartholt KA, Mattace-Raso FUS, et al. Effectiveness of medication withdrawal in older fallers: results from the improving medication prescribing to reduce risk of falls (IMPROveFALL) trial. Age Ageing. 2017;46(1):142–6.

    PubMed  Google Scholar 

  25. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc. 1999;7(7):850–3.

    Article  Google Scholar 

  26. Centers for Disease Control and Prevention (CDC). STEADI stopping elderly accidents, deaths, and injuries. 2020. https://www.cdc.gov/steadi/about.html. Accessed 14 Sep 2020.

  27. Aspinall SL, Hanlon JT, Niznik JD, Springer SP, Thorpe CT. Deprescribing in older nursing home patients: focus on innovative composite measures for dosage deintensification. Innov Aging. 2017;1(2):igx031.

  28. Flodgren G, O'Brien MA, Parmelli E, Grimshaw JM. Local opinion leaders: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2019;24(6):CD000125.

  29. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009;8(3):CD001096.

  30. Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. Am J Epidemiol. 2010;171(9):1031–6.

    Article  Google Scholar 

  31. Hartholt KA, Boyé ND, Van der Velde N, Van Lieshout EM, Polinder S, De Vries OJ, et al. [Cost] effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study). BMC Geriatr. 2011;383(2):129–40.

    Google Scholar 

  32. deprescribing.org. Deprescribing Guidelines and Algorithms. 2020. https://deprescribing.org/resources/deprescribing-guidelines-algorithms. Accessed 27 Aug 2020.

  33. Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807.

    Article  Google Scholar 

  34. Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8.

    Article  Google Scholar 

  35. Bhasin S, Gill TM, Reuben DB, Latham NK, Ganz DA, Greene EJ, et al. A randomized trial of a multifactorial strategy to prevent serious fall injuries. N Engl J Med. 2020;383(2):129–40.

    Article  Google Scholar 

  36. Paquin AM, Zimmerman K, Rudolph JL. Risk versus risk: a review of benzodiazepine reduction in older adults. Expert Opin Drug Saf. 2014;13(7):919–34.

    Article  CAS  Google Scholar 

  37. Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial. JAMA. 2018;320(18):1889–98.

    Article  Google Scholar 

  38. Morello RT, Soh S-E, Behm K, Egan A, Ayton D, Hill K, et al. Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis. Inj Prev. 2019;25(6):557–64.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pharmacy, School of Pharmacy, University of Washington, Health Sciences Building, H-361D, Box 357630, Seattle, Washington, 98195-7630, USA

    Shelly L. Gray & Zizi Elsisi

  2. Department of Medicine (Geriatrics), School of Medicine, University of Washington, Seattle, Washington, USA

    Elizabeth A. Phelan

  3. Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA

    Elizabeth A. Phelan

  4. Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Joseph T. Hanlon

  5. Education, and Clinical Center, Geriatric Research, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Joseph T. Hanlon

  6. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Joseph T. Hanlon

Authors
  1. Shelly L. Gray
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  2. Zizi Elsisi
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  3. Elizabeth A. Phelan
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  4. Joseph T. Hanlon
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Corresponding author

Correspondence to Shelly L. Gray.

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Funding

Drs. Gray and Phelan are funded by a Centers for Disease Control and Prevention Cooperative Agreement (U01CE002967). Dr. Hanlon receives funding from a VA Health Services Research and Development grant (IIR 18-228).

Conflict of Interest

Shelly Gray, Joseph Hanlon, Elizabeth Phelan, and Zizi Elsisi have no conflicts of interest to declare.

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Author Contributions

JH conducted the literature review. All authors agreed on eligible studies. JH, SG, and ZE summarized and critiqued eligible studies. Authors shared responsibility for drafting the manuscript. All authors interpreted results and reviewed, edited, and approved the final manuscript submitted.

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Gray, S.L., Elsisi, Z., Phelan, E.A. et al. Interventions to Reduce Fall-Risk-Increasing Drug Use to Prevent Falls: A Narrative Review of Randomized Trials. Drugs Aging 38, 301–309 (2021). https://doi.org/10.1007/s40266-021-00835-9

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