How Polypharmacy Is Increasing Fall Risk for Older Adults
Between 1988–1994 and 2013–2014, older adults, age 65 and older, reporting the use of five or more prescription drugs, also known as polypharmacy, in the prior 30 days rose 28.4 percentage points. Deprescribing – the process of identifying and discontinuing selected medications – is one intervention that focuses on addressing polypharmacy. The deprescribing process should involve shared decision making between the patient, caregiver(s), and the interprofessional care team, with what matters to the patient serving as the foundation of the efforts.
The deprescribing process should incorporate:
- Conducting a comprehensive medication history and review
- Identifying potentially inappropriate medications (PIMs), such as those likely to cause adverse effects, potential harms that outweigh potential benefits, lack of therapeutic efficacy, and lack of indication
- Determining if the selected medications can be ceased and prioritizing the order of discontinuation
- Planning and initiating withdrawal
- At this stage, providers should consider beginning by halving the dose or reducing to the next available dosage form. Continue to reassess and adjust over time. Additionally, one medication should be stopped at a time to assess potential benefits and harms.
- Providing monitoring support and documentation of the deprescribing process, including patient education tools.
Following are evidence-based tools to initiate a medication assessment in older adults:
- American Geriatrics Society (AGS) publishes the Beers Criteria® for Potentially Inappropriate Medication (PIM) Use in Older Adults
- Screening tool of older persons’ potentially inappropriate prescriptions (STOPP)
- Screening tool to alert doctors to the right treatment (START)
Multiple risk factors in the Hendrich II Fall Risk Model® cite deprescribing as a potential intervention to modify the patient’s fall risk, including Confusion/Disorientation/Impulsivity; Symptomatic Depression; and Dizziness/Vertigo. The Hendrich research also demonstrated that two drug classes always increase fall risk: antiepileptics (or anticonvulsants) and benzodiazepines. Patients who take these two classes of drugs have a higher risk of falling due to the impact on the central nervous system and the drugs’ side effects.
Chou J., Tong M., Brandt N., 2019. Combating Polypharmacy Through Deprescribing Potentially Inappropriate Medications. J Gerontol Nurs. 45(1) 9-15. doi: 10.3928/00989134-20190102-01
National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, Maryland. 2017
Reeve, E., Shakib, S., Hendrix, I., Roberts, M.S., & Wiese, M.D., 2014. Review of deprescribing processes and development of an evidence-based, patient-centered deprescribing process. British Journal of Clinical Pharmacology, 78, 738-747. doi: 10.1111/bcp.12386