Drugs & Aging

, Volume 36, Issue 5, pp 461–470 | Cite as

Modification of Potentially Inappropriate Prescribing Following Fall-Related Hospitalizations in Older Adults

  • Mary E. WalshEmail author
  • Fiona Boland
  • Frank Moriarty
  • Tom Fahey
Original Research Article



There is strong evidence that potentially inappropriate prescribing is associated with falls in older adults. Fall-related hospitalizations should trigger medication review.


The aim of this before-and-after cohort study was to explore patterns of relevant potentially inappropriate prescribing in older people with fall-related hospitalizations.


Data on older adults with hospitalizations for falls, fractures and syncope between 2012 and 2016 were collected from 44 general practices in Ireland. Fall-related prescribing was defined from the Screening Tool for Older Persons’ Prescriptions (sedatives and vasodilators) and the Screening Tool to Alert doctors to Right Treatment (vitamin D). Prevalence of prescriptions were estimated from general practice and hospital discharge records. Mixed-effects logistic regression was conducted to compare the 12-month pre- and post-hospitalization periods.


Overall, 927 individuals (68% female, average age 81.2 years; standard deviation 8.6) were included, 45% of whom had a diagnosis of fracture, 28% had syncope, and 27% had a fall without fracture/syncope. After adjustment for covariates and practice clustering effects, both vitamin D and sedatives had higher odds of prescription post-hospitalization (adjusted odds ratio [aOR] 4.47, 95% confidence interval [CI] 2.09–9.54, and aOR 1.75, 95% CI 1.29–2.39, respectively). With adjustments for age and sex, having a fracture was associated with new initiation of vitamin D (aOR 2.81, 95% CI 1.76–4.46) and having syncope was associated with continuing on vasodilators (aOR 1.99, 95% CI 1.06–3.74). No factors were associated with new sedative initiation.


Fall-related potentially inappropriate prescribing is prevalent in older adults who have a history of falls, and continues after discharge from hospital. Future studies should investigate why such prescribing is initiated after a fall-related hospitalization, and explore interventions that could reduce such hazardous prescribing.



The authors gratefully acknowledge the contributions of all participating general practitioners and patients.

Compliance with Ethical Standards


This study was funded by the Health Research Board (HRB) in Ireland through Grant no. HRC/2014/1 (TF).

Conflicts of interest

Mary E. Walsh, Fiona Boland, Frank Moriarty and Tom Fahey declare that they have no conflicts of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Supplementary material

40266_2019_646_MOESM1_ESM.pdf (574 kb)
Supplementary material 1 (PDF 574 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.HRB Centre for Primary Care Research, Department of General PracticeRoyal College of Surgeons in IrelandDublin 2Ireland

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