Department of Emergency Medicine, Cooper Medical School at Rowan University, Cooper University Hospital, Camden, New Jersey, USA.
Division of Geriatric Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA.
J Am Geriatr Soc. 2024 Aug;72 Suppl 3:S60-S67. doi: 10.1111/jgs.18947. Epub 2024 May 8.
Over 35 million falls occur in older adults annually and are associated with increased emergency department (ED) revisits and 1-year mortality. Despite associations between medications and falls, the prevalence of fall risk-increasing drugs remains high. Our objective was to implement an ED-based medication reconciliation for patients presenting after falls and determine whether an intervention targeting high-risk medications was related to decreased future falls.
This was an observational prospective cohort study at a single site in the United States. Adults 65 years and older presenting to the ED after falls had a pharmacist review their medicines. Pharmacists made recommendations to taper, stop, or discuss medications with the primary clinician. At 3, 6, and 12 months, we recorded the number of fall-related return ED visits and determined if recommended medication changes had been implemented. We compared the rate of return visits of patients who had followed the medication change recommendations and those who received recommendations but had no change in their medications using chi-square tests.
A total of 577 patients (mean age 81 years, 63.6% female) were enrolled of 1509 potentially eligible patients. High-risk medications were identified in 310 patients (53.7%) who received medication recommendations. High-risk medications were associated with repeat fall-related visits at 12 months (risk difference 8.1% [95% confidence interval 0.97-15.0]). A total of 134 (43%) patients on high-risk medications had evidence of medication modification. At 12 months, there was no statistically significant difference in return fall visits between patients who had modifications to medications compared with those who had not implemented changes (p = 0.551).
Our findings identified opportunities for medication optimization in over half of emergency visits for falls and demonstrated that medication counseling in the ED is feasible. However, evaluation of the effect on future falls was limited.
每年有超过 3500 万老年人发生跌倒，这与急诊科（ED）复诊率增加和 1 年死亡率升高有关。尽管药物与跌倒之间存在关联，但增加跌倒风险的药物的流行率仍然很高。我们的目的是为跌倒后就诊的患者实施 ED 药物重整，并确定针对高危药物的干预措施是否与未来跌倒减少相关。
这是在美国一个单一地点进行的观察性前瞻性队列研究。65 岁及以上因跌倒就诊于 ED 的成年人，由药剂师审查其药物。药剂师向初级临床医生提出减少、停止或讨论药物的建议。在 3、6 和 12 个月时，我们记录了与跌倒相关的返回 ED 就诊的次数，并确定是否实施了推荐的药物更改。我们比较了遵循药物更改建议的患者和接受建议但药物未发生变化的患者的复诊率，使用卡方检验进行比较。
共纳入了 577 名患者（平均年龄 81 岁，63.6%为女性），其中 1509 名潜在符合条件的患者中有 577 名患者入组。310 名患者（53.7%）确定存在高危药物，这些患者收到了药物建议。高危药物与 12 个月时的重复跌倒相关就诊有关（风险差异 8.1%[95%置信区间 0.97-15.0]）。134 名（43%）服用高危药物的患者有药物调整的证据。在 12 个月时，与未进行药物改变的患者相比，接受药物调整的患者的跌倒复诊率没有统计学上的显著差异（p=0.551）。
我们的研究结果发现，在因跌倒就诊的患者中，有超过一半的患者有药物优化的机会，并表明 ED 中的药物咨询是可行的。然而，对未来跌倒影响的评估受到限制。
