Shelly L Gray1, Zizi Elsisi2, Elizabeth A Phelan3,4, Joseph T Hanlon5,6,7. 1. Department of Pharmacy, School of Pharmacy, University of Washington, Health Sciences Building, H-361D, Box 357630, Seattle, Washington, 98195-7630, USA. slgray@uw.edu. 2. Department of Pharmacy, School of Pharmacy, University of Washington, Health Sciences Building, H-361D, Box 357630, Seattle, Washington, 98195-7630, USA. 3. Department of Medicine (Geriatrics), School of Medicine, University of Washington, Seattle, Washington, USA. 4. Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA. 5. Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 6. Education, and Clinical Center, Geriatric Research, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA. 7. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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.
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.
Authors: Nicole D A Boyé; Nathalie van der Velde; Oscar J de Vries; Esther M M van Lieshout; Klaas A Hartholt; Francesco U S Mattace-Raso; Paul Lips; Peter Patka; Ed F van Beeck; Tischa J M van der Cammen Journal: Age Ageing Date: 2017-01-10 Impact factor: 10.668
Authors: Elizabeth A Phelan; Eileen Rillamas-Sun; Lisa Johnson; Michael J LaMonte; David M Buchner; Andrea Z LaCroix; Garnet L Anderson Journal: Inj Prev Date: 2020-01-15 Impact factor: 2.399