The prescribing patterns in geriatric patients with falls and fractures remain inappropriate

Abstract

Aims: To assess the appropriateness of prescribing in older patients drugs related to falls and osteoporotic fractures (psychoactive, anti‐osteoporotic, anti‐anaemic).

Methods: We analysed two cohorts of hospitalised patients: 807 medical (mean age 86.4 ± 6.2 years, 63.8% females) and 455 with hip fracture (HF) (mean age 82.8 ± 8.4 years, 74.0% females). Clinical and laboratory data were collected prospectively, appropriateness of medication use (Beers 2015 and STOPP criteria) and risk of osteoporosis were assessed (Osteoporosis Self‐assessment Tool, OST).

Results: Among medical patients, 508 (71.1%) had high osteoporosis risk (OST <−3), 167 (20.7%) had history of falls, 127 (15.7%) had previous fractures and 505 (62.6%) were anaemic (mostly iron deficient). However, on admission 66 (39.6%) fallers and 47 (37.0%) patients with previous fractures were using at least one falls‐risk psychoactive medication: an antidepressant (18.6% and 17.3%, respectively), benzodiazepine (6.6% and 9.4%) or antipsychotic (14.4% and 10.2%) with potentially inappropriate prescriptions in 66.7% and 83.0%, respectively. Anti‐resorptive therapies received only 81 (15.9%) patients with high osteoporosis risk, including 53 (18.0%) with previous falls and fractures; iron supplements used only 54 (10.7%) patients with anaemia (12 [14.4%] fallers). Similarly, amongst 455 HF patients, 137 (30.1%) were treated with psychoactive medicines (in 98 [71.5%] prescribed inappropriately) but only 83 (18.2%) subjects were receiving anti‐osteoporotic drugs and only 29 (7.6%) of 383 anaemic patients were prescribed iron supplements.

Conclusions: The prevalence of unnecessary psychoactive medications use, underutilised anti‐osteoporotic and anti‐anaemic therapies in the elderly is high. Improvement of prescribing should be considered as an essential component in preventing falls and fractures. Show more