Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study

Abstract

Background: Hip fractures constitute a major health problem in elderly people and are often fall-related. Several factors can contribute to a fall episode leading to hip fracture, including fall-risk-increasing drugs (FRIDs), which are often used by elderly people. We aimed to investigate the prevalence of medication-related falls and to assess the role of FRIDs and potentially inappropriate medications (PIMs) in a population of elderly patients hospitalized for a hip fracture.

Methods: We reviewed the patient records of 200 consecutive patients, aged ≥65 years, who were admitted for a hip fracture and evaluated whether medications were likely to have contributed to the fall episode. PIMs were identified using the Screening Tool of Older Persons' Prescriptions version 2 (STOPP) and by evaluating indications, contra-indications and interactions of the prescribed medications for each patient.

Results: FRIDs were used by 175 patients (87.5%). Medications were considered a likely contributor to the fall in 82 patients (41%). These were most often psychotropic medications alone or in combination with antihypertensives and/or diuretics. The 82 patients with suspected medication-related falls used more medications, FRIDs and PIMs than the rest of the patients, and in 74 (90%) of the 82 patients, at least one medication considered to be a contributor to the fall was also a PIM.

Conclusions: The prevalence of suspected medication-related falls was 41%. It seems likely that a medication review could have reduced, though not eliminated, the risk of falling in this group of patients.

Keywords: Fall; Fall-risk-increasing drugs; Geriatrics; Polypharmacy; Potentially inappropriate medication.

Fig. 1

Main causes of falls. Figure 1. Flow diagram showing the selection procedure for the patients having a medication-related fall, as evaluated with the joint expertise of a clinical pharmacologist and a geriatrician

Fig. 2

Medications most commonly suspected of contributing to falls. Figure 2. Drug classes most frequently suspected to contribute to the fall in patients with a suspected medication-related fall (group 5, Fig. 1). Left axis shows the crude number of patients in which the drug contribute. Right axis shows the percentage. Abbreviations: SSRI: selective serotonin reuptake inhibitors, ACE: angiotensin-II converting enzyme, AT-II: angiotensin-II receptor, NaSSa: Noradrenergic and specific serotonergic antidepressants