European position paper on polypharmacy and fall-risk-increasing drugs recommendations in the World Guidelines for Falls Prevention and Management: implications and implementation

Nathalie van der Velde; Lotta J Seppala; Sirpa Hartikainen; Nellie Kamkar; Louise Mallet; Tahir Masud; Manuel Montero-Odasso; Eveline P van Poelgeest; Katja Thomsen; Jesper Ryg; Mirko Petrovic; EuGMS Task, Finish Group on Fall-risk-increasing drugs

doi:10.1007/s41999-023-00824-8

European position paper on polypharmacy and fall-risk-increasing drugs recommendations in the World Guidelines for Falls Prevention and Management: implications and implementation

Eur Geriatr Med. 2023 Aug;14(4):649-658. doi: 10.1007/s41999-023-00824-8. Epub 2023 Jul 15.

Authors

Nathalie van der Velde^#^{1

2}, Lotta J Seppala^#^{3

4}, Sirpa Hartikainen⁵, Nellie Kamkar^{6

7}, Louise Mallet^{8

9}, Tahir Masud¹⁰, Manuel Montero-Odasso^{6

11

12}, Eveline P van Poelgeest^{3

4}, Katja Thomsen^{13

14}, Jesper Ryg^{13

14}, Mirko Petrovic¹⁵; EuGMS Task, Finish Group on Fall-risk-increasing drugs

Affiliations

¹ Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands. n.vandervelde@amsterdamumc.nl.
² Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. n.vandervelde@amsterdamumc.nl.
³ Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
⁵ School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
⁶ Gait and Brain Laboratory, Lawson Research Health Institute, Parkwood Hospital, London, ON, Canada.
⁷ Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
⁸ Faculty of Pharmacy, University of Montreal, Montréal, Québec, Canada.
⁹ Department of Pharmacy and Geriatrics, McGill University Health Center, Montréal, QC, Canada.
¹⁰ Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹¹ Schulich School of Medicine and Dentistry, London, ON, Canada.
¹² Departments of Medicine (Geriatrics) and of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
¹³ Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
¹⁴ Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹⁵ Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

^# Contributed equally.

Abstract

Falls prevention and management in older adults is a critical global challenge. One of the key risk factors for falls is the use of certain medications. Therefore, to prevent medication-related falls, the following is recommended in the recent World Guidelines for Falls Prevention and Management: (1) assess for fall history and the risk of falls before prescribing potential fall-risk-increasing drugs (FRIDs), (2) use a validated, structured screening and assessment tool to identify FRIDs when performing a medication review, (3) include medication review and appropriate deprescribing of FRIDs as a part of the multifactorial falls prevention intervention, and (4) in long-term care residents, if multifactorial intervention cannot be conducted due to limited resources, the falls prevention strategy should still always include deprescribing of FRIDs.In the present statement paper, the working group on medication-related falls of the World Guidelines for Falls Prevention and Management, in collaboration with the European Geriatric Medicine Society (EuGMS) Task and Finish group on FRIDs, outlines its position on how to implement and execute these recommendations in clinical practice.Preferably, the medication review should be conducted as part of a comprehensive geriatric assessment to produce a personalized and patient-centered assessment. Furthermore, the major pitfall of the published intervention studies so far is the suboptimal implementation of medication review and deprescribing. For the future, it is important to focus on gaining which elements determine successful implementation and apply the concepts of implementation science to decrease the gap between research and practice.

Keywords: Adverse drug reactions; Deprescribing; Fall-risk-increasing drugs; Falls prevention; Implementation; Medication review; Polypharmacy.

MeSH terms

Accidental Falls / prevention & control
Aged
Geriatrics*
Humans
Long-Term Care
Polypharmacy*
Risk Factors