Inpatient referrals to a specialist falls and syncope service: prevalence of STOPPFall FRIDs and review of deprescribing patterns

Abstract

Purpose: Falls are the commonest cause of accidental death in older people and the most frequent reason for their presentation to hospital. The Screening Tool of Older Persons Prescriptions in older adults with high falls risk (STOPPFall) facilitates deprescribing by providing a clear consensus on which medications are considered fall-risk-increasing drugs (FRIDs). This study aimed to determine the prevalence of STOPPFall FRIDs in inpatients referred to a falls and syncope service (FASS). Additionally, we aimed to analyse the impact of a dedicated FASS on deprescribing, both of FRIDs and of non-FRID medications.

Methods: We conducted a retrospective observational study of all FASS inpatient consultations over a 6-month period (March-August 2021). Patients ≥ 65 years old were included. Medications on admission and discharge (following FASS assessment) were reviewed, with FRIDs identified using the STOPPFall deprescribing tool. The prevalence of FRIDs was defined as the proportion of patients who had at least one regular FRID prescribed on admission.

Results: In total, 162 patients were included for review: 54.94% were (n = 89) female. The mean age of patients was 79.26 years (SD 7.45). STOPPFall FRIDs were prevalent, with 74.07% (120/162) on at least 1 regular FRID. Antidepressants (37.04%, n = 60) and diuretics (27.78%, n = 45) were the most frequently prescribed FRID classes. Of patients with a fracture, the mean number of FRIDs was 2.44 versus 1.56 in those without fracture (p = 0.01). At least one FRID was stopped in 35. 8% (n = 58) of patients. Following FASS review, 28.6% (n = 79) of all admission FRIDs were discontinued.

Conclusion: STOPPFall FRIDs are prevalent in patients referred for inpatient FASS consultations. Presentations with acute fracture are associated with higher number of FRIDs on admission. Review by a dedicated hospital falls service leads to a reduction in FRIDs and deprescribing of anti-hypertensive medications.

Keywords: Fall-risk-increasing drugs; Falls; Older adults.