Abstract
Background: Falls are common presenting complaints in older adults, particularly those aged 65 and above, with prevalence increasing with age. The risk of falls is multifactorial, and polypharmacy, defined as the use of five or more medications, is one of the significant modifiable risk factors. Inappropriate medication use, which occurs in 30-50% of cases in the elderly, exacerbates this risk.
Objective: This audit aimed to assess the impact of polypharmacy on fall risk among elderly patients and evaluate the effectiveness of medication reconciliation in reducing this risk. The study was conducted in an elderly ward at Maidstone Hospital.
Methods: The audit included patients on polypharmacy, assessing their fall risk and the appropriateness of their medication reconciliation. High-risk medications, such as diuretics, benzodiazepines, antidepressants, and antiparkinsonian drugs, were identified and analyzed for their contribution to fall risk. Tools used were EPR software to look at prescription orders, worksheets, documentation for falls risk, and medication reconciliation.
Results: 84% of patients were taking more than four medications. 80% of patients were on high-risk medications. 32% of patients had unreconciled medications, although pharmacists performed other reconciliations. Nearly 50% of patients had either medium or high fall risk.
Recommendations:
1. Conduct regular reviews of patients' medications, emphasizing the importance of medication reconciliation at admission and whenever prescriptions change.
2. Implement departmental teaching on polypharmacy and medication reconciliation for both doctors and pharmacists in the frailty department.
3. Utilize the START/STOPP criteria to review medications, ensuring compliance with NICE standards for medication reconciliation. These measures aim to reduce the risk of falls and other adverse effects associated with polypharmacy in the elderly.