Background: This paper reports findings from a literature review undertaken to assess the current evidence base for clinical medication review and falls in older people. This forms part of a larger, organisational supported project design work-stream, where the objectives are to define the operational details for clinical medication review as part of multi-factorial assessment for elderly fallers in the community. Patients will be identified and targeted through an integrated care pathway mapping and elderly patient care screening service. Objective: A review of national and best practice guidance to help our understanding of how clinical medication review could be optimised. Methods: A PubMed database search was undertaken with search terms including “elderly” and “falls” and “medicines” followed by study of relevant publications in English and including cited referenced publications within selected papers. Results: Our findings were that both medication over-use and under-use in the elderly occur frequently and can be harmful. Many drugs commonly used by older persons have not been systematically studied as risk factors for falls. The screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START), validated for assessment of potentially inappropriate prescribing in the elderly, offer the possibility of provision of a structured clinical medication review to patients, with a need for more research on the impact of the STOPP START interventions on both the rates of falls and risk of falls in the elderly.
References
[1]
Department of Health (2009) The Prevention Package for Older People. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/ Publicationsandstatistics/Publications/dh_103146
[2]
World Health Organisation (2012) Falls. WHO Factsheet No 344. http://www.who.int/mediacentre/factsheets/fs344/en/
[3]
Kannus, P., Sievãnen, H., Palvanen, M., Jãrvinen, T. and Parkkari, J. (2005) Prevention of Falls and Consequent Injuries in Elderly People. Lancet, 366, 1885-1893. http://dx.doi.org/10.1016/S0140-6736(05)67604-0
[4]
Centers for Disease Control and Prevention (CDC) (2006) Fatalities and Injuries from Falls among Older Adults— United States, 1993-2003 and 2001-2005. Morbidity and Mortality Weekly Report, 55, 1221-1224.
[5]
Rubenstein, L.Z. (2006) Falls in Older People: Epidemiology, Risk Factors and Strategies for Prevention. Age and Ageing, 35, 37-41. http://dx.doi.org/10.1093/ageing/afl084
[6]
Cameron, I.D., Gillespie, L.D., Robertson, M.C., Murray, G.R., Hill, K.D., Cumming, R.G. and Kerse, N. (2012) Interventions for Preventing Falls in Older People in Care Facilities and Hospitals. Cochrane Database of Systematic Reviews, No. 12, Article No.: CD005465. http://dx.doi.org/10.1002/14651858.CD005465.pub3
[7]
Lin, F.R. and Ferrucci, L. (2012) Hearing Loss and Falls among Older Adults in the United States. Archives of Internal Medicine, 172, 369-371. http://dx.doi.org/10.1001/archinternmed.2011.728
[8]
Viljanen, A., Kaprio, J., Pyykkö, I., Sorri, M., Koskenvuo, M. and Rantanen, T. (2009) Hearing Acuity as a Predictor of Walking Difficulties in Older Women. Journal of the American Geriatrics Society, 57, 2282-2286. http://dx.doi.org/10.1111/j.1532-5415.2009.02553.x
[9]
Skalska, A., Wizner, B., Piotrowicz, K., Klich-Raczka, A., Klimek, E., Mossakowska, M., et al. (2013) The Prevalence of Falls and Their Relation to Visual and Hearing Impairments among a Nation-Wide Cohort of Older Poles. Experimental Gerontology, 48, 140-146. http://dx.doi.org/10.1016/j.exger.2012.12.003
[10]
Crowe, K. (2013) Increasing Isolation in a Confusing World: Dementia with Age Related Hearing Impairment. Old Age Psychiatrist, 55.
[11]
Department of Health (2009) Hip Fracture including the Secondary Prevention of Further Fractures Related to Falls and Bone Fragility. http://www.pathwaysforhealth.org/application/render08.asp?reference=E866CB3073 EF4E0CA4289A3A0C20407E
[12]
Laybourne, A.H., Martin, F.C., Whiting, D.G. and Lowton, K. (2011) Could Fire and Rescue Services Identify Older People at Risk of Falls? Primary Health Care Research & Development, 12, 395-399. http://dx.doi.org/10.1017/S1463423611000120
[13]
British Geriatrics Society (2014) Fit for Frailty. Consensus Best Practice Guidance for the Care of Older People Living with Frailty in Community and Outpatient Settings. British Geriatrics Society in Association with the Royal College of General Practitioners and Age UK. http://www.bgs.org.uk/campaigns/fff/fff_full.pdf
[14]
Robb, E., Jarman, B., Suntharalingam, G., Higgens, C., Tennant, R. and Elcock, K. (2010) Using Care Bundles to Reduce In-Hospital Mortality: Quantitative Survey. BMJ, 340, c1234. http://dx.doi.org/10.1136/bmj.c1234
[15]
NICE (2013) Falls in Older People: Assessing Risk and Prevention. Guidelines CG161. http://www.nice.org.uk/guidance/cg161/chapter/recommendations
[16]
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J., O’Mahony, D., STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) (2008) Consensus Validation. International Journal of Clinical Pharmacology and Therapeutics, 46, 72-83. http://dx.doi.org/10.5414/CPP46072
[17]
Gallagher, P., Baeyens, J.P., Topinkova, E., Madlova, P., Cherubini, A., Gasperini, B., et al. (2009) Inter-Rater Reliability of STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) Criteria amongst Physicians in Six European Countries. Age and Ageing, 38, 603-606. http://dx.doi.org/10.1093/ageing/afp058
[18]
Bjelakovic, G., Gluud, L.L., Nikolova, D., Whitfield, K., Wetterslev, J., Simonetti, R.G., et al. (2014) Vitamin D Supplementation for Prevention of Mortality in Adults. Cochrane Database of Systematic Reviews, No. 1, Article ID: CD007470.
[19]
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M. and Lamb, S.E. (2012) Interventions for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews, No. 9, Article ID: CD007146. http://dx.doi.org/10.1002/14651858.CD007146.pub3
[20]
Beer, C., Hyde, Z., Almeida, O.P., Norman, P., Hankey, G.J., Yeap, B.B. and Flicker, L. (2011) Quality Use of Medicines and Health Outcomes among a Cohort of Community Dwelling Older Men: An Observational Study. British Journal of Clinical Pharmacology, 71, 592-599. http://dx.doi.org/10.1111/j.1365-2125.2010.03875.x
[21]
Gnjidic, D., Hilmer, S.N., Blyth, F.M., Naganathan, V., Waite, L., Seibel, M.J., et al. (2012) Polypharmacy Cutoff and Outcomes: Five or More Medicines Were Used to Identify Community-Dwelling Older Men at Risk of Different Adverse Outcomes. Journal of Clinical Epidemiology, 65, 989-995. http://dx.doi.org/10.1016/j.jclinepi.2012.02.018
[22]
Hartikainen, S., Lönnroos, E. and Louhivuori, K. (2007) Medication as a Risk Factor for Falls: Critical Systematic Review. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62, 1172-1181. http://dx.doi.org/10.1093/gerona/62.10.1172
[23]
Veal, F.C., Bereznicki, L.R., Thompson, A.J. and Peterson, G.M. (2014) Pharmacological Management of Pain in Australian Aged Care Facilities. Age and Ageing, 43, 851-856. http://dx.doi.org/10.1093/ageing/afu072
[24]
Nishtala, P.S., Narayan, S.W., Wang, T. and Hilmer, S.N. (2014) Associations of Drug Burden Index with Falls, General Practitioner Visits, and Mortality in Older People. Pharmacoepidemiology and Drug Safety, 23, 753-758. http://dx.doi.org/10.1002/pds.3624
[25]
Berthoux, E., Dufour, C., Raharisondraibe, E. and Bonnefoy, M. (2013) Preventable Drug Events in Acute Geriatric Unit. Gériatrie et Psychologie Neuropsychiatrie du Vieillissement, 11, 15-20.
[26]
Rhalimi, M., Helou, R. and Jaeker, P. (2009) Medication Use and Increased Risk of Falls in Hospitalized Elderly Patients: A Retrospective, Case-Control Study. Drugs & Aging, 26, 847-852. http://dx.doi.org/10.2165/11317610-000000000-00000
[27]
Payne, R.A., Abel, G.A., Simpson, C.R. and Maxwell, S.R. (2013) Association between Prescribing of Cardiovascular and Psychotropic Medications and Hospital Admission for Falls or Fractures. Drugs & Aging, 30, 247-254. http://dx.doi.org/10.1007/s40266-013-0058-z
[28]
Vitry, A.I., Hoile, A.P., Gilbert, A.L., Esterman, A. and Luszcz, M.A. (2010) The Risk of Falls and Fractures Associated with Persistent Use of Psychotropic Medications in Elderly People. Archives of Gerontology and Geriatrics, 50, e1-e4. http://dx.doi.org/10.1016/j.archger.2009.04.004
[29]
Onatade, R., Auyeung, V., Scutt, G. and Fernando, J. (2013) Potentially Inappropriate Prescribing in Patients on Admission and Discharge from an Older Peoples’ Unit of an Acute UK Hospital. Drugs & Aging, 30, 729-737. http://dx.doi.org/10.1007/s40266-013-0097-5
[30]
Wahab, M.S., Nyfort-Hansen, K. and Kowalski, S.R. (2012) Inappropriate Prescribing in Hospitalised Australian Elderly as Determined by the STOPP Criteria. International Journal of Clinical Pharmacy, 34, 855-862. http://dx.doi.org/10.1007/s11096-012-9681-8
[31]
Zermansky, A.G., Alldred, D.P., Petty, D.R., Raynor, D.K., Freemantle, N., Eastaugh, J. and Bowie, P. (2006) Clinical Medication Review by a Pharmacist of Elderly People Living in Care Homes—Randomised Controlled Trial. Age and Ageing, 35, 586-591. http://dx.doi.org/10.1093/ageing/afl075
[32]
Wilcock, M., MacMahon, D. and Woolf, A. (2005) Use of Medicines That Influence Falls or Fractures in a Residential Home Setting. Pharmacy World and Science, 27, 220-222. http://dx.doi.org/10.1007/s11096-004-3707-9
[33]
Tanna, N. (2004) Care of the Elderly—An Osteoporosis Medication Management Clinic. Hospital Pharmacist, 11, 231-238.
[34]
Cipolle, R.J., Strand, L.M. and Morley, P.C. (1998) Pharmaceutical Care Practice. McGraw-Hill, Health Professions Division, New York.
[35]
Cipolle, R.J., Strand, L.M. and Morley, P.C. (2012) Pharmaceutical Care Practice: The Patient Centered Approach to Medication Management. 3rd Edition, McGraw-Hill, Health Professions Division, New York.
Tanna, N., Batten, C., Pitkin, J., Rogers, P. and Kelham, C. (2005) Shared Decision Making and Care Planning with Patients. The Journal of the British Menopause Society, 11, 180.
[38]
Tanna, N., Batten, C., Pitkin, J., Rogers, P. and Kelham, C. (2007) Evaluation of a Medication Management Clinic Service, Using Action Research Methodology. Osteoporosis International, 18, S310.
[39]
Marshall, M., Pronovost, P. and Dixon-Woods, M. (2013) Promotion of Improvement as a Science. The Lancet, 381, 419-421. http://dx.doi.org/10.1016/S0140-6736(12)61850-9