|
APPROPRIATENESS OF USE OF MEDICINES FOR PATIENTS AT RISK OF FALLS ADMITTED IN GERIATRIC UNITS
Jankovic A, de Sylva C, Fiorito S, Flores Vivian G, De Breucker S, Kalitventzeff S, Pepersack T.
Introduction: Medication use is one of the most modifiable risk factors for falls. An assessment of fall risk should be integrated into the history and physical examination of all geriatric patients, even those not specifically being seen for a problem with falling. A complete medication history should focus specifically upon vasodilators, diuretics, and sedative hypnotic drugs. Multiple preventive intervention studies have been conducted over the past decade, including programs to improve strength or balance, educational programs, environmental modifications in homes or institutions, and optimization of medication.
Objectives: To assess at admission and at discharge the medications use of geriatric hospitalized patients according to their risk of falls.
Design: Prospective observational survey.
Methods: The charts consecutive admissions in an acute geriatric unit were prospectively studied by pharmacist trainees between November and December 2005. A checklist of twenty classes of drugs potentially associated with a risk of falls was systematically reviewed. The risk of falls was assessed using the Stratify score.
Limitations: The analysis of the data did not include the comorbidity.
Results: Thirty-four patients (median age 83 yr, range 72-99) were admitted for a median length of stay of 16 days. Sixty-two percents were admitted for a falls and/or were at risk of falls according to the Stratify score. The median number of drugs was 6/day (range 1 to 15) at admission and 6.5/day at discharge. The proportion of patients receiving benzodiazepines (BZD) at discharge tended to decrease (32% at discharge vs 50% at admission, p=0.0668). Comparing the medications of the patients according to their risk of falls, we observed 62% of patients at risk of falls who received benzodiazepines versus 32% of patients in the group presenting no risk at admission (p=0.043). Still 38% of the patients of the group at risk of falls received BZD at discharge (ns, p=0.063). Only 5% of the patients at risk received beta-blockers at discharge versus 31% of the patients presenting no risk of falls (p= 0.023).
Discussion: The number of prescribed drugs did not decrease at discharge even if the number of drugs potentially associated with a risk of falls tended to decrease. This survey should be the first step of a quality program to improve the appropriateness of use of medicines for patients admitted in our geriatric unit.
|
- GO BACK - |
