title: Influence of Admission to a Tertiary Care Hospital after a Fall on Use of Potentially Inappropriate Medications among Older Patients.
abstract: BACKGROUND
  Each year, about one-third of individuals over the age of 65 years will experience a fall, and half of these will experience a subsequent fall in the following year. The use of potentially inappropriate medications (PIMs) is an important factor contributing to increased fall risk in geriatric patients.
  
  
  OBJECTIVE
  To determine the proportion of patients over the age of 65 admitted to orthopedics and general medicine services with diagnosis of a fall who experienced a change in the total number or dosage of PIMs, as defined by the Beers criteria, upon discharge from hospital.
  
  
  METHODS
  This retrospective observational study involved patients admitted to a tertiary care hospital with diagnosis of a fall between January 1 and December 31, 2011. Those aged 65 years or older with at least one PIM on admission were eligible for inclusion. Data analysis included χ(2) and Fisher testing, as well as multivariate analysis.
  
  
  RESULTS
  A total of 148 patients were included, of whom 63 (43%) had an overall change in the dosage or number of PIMs during their hospital stay. Forty patients (27%) had an overall reduction in the dosage or number of PIMs upon discharge from hospital, whereas 23 (16%) experienced an overall increase in the dosage or total number of PIMs. The mean number (± standard deviation) of PIMs decreased during the hospital stay, from 1.6 ± 0.8 on admission to 1.4 ± 0.9 on discharge (p = 0.03). Benzodiazepines were the class of PIMs most frequently discontinued or reduced in dosage.
  
  
  CONCLUSIONS
  One-quarter of patients admitted with falls had de-escalation of PIMs upon hospital discharge. Although dosage reduction or drug discontinuation may not be appropriate for all patients, a standardized approach to medication review during the hospital stay and improved prescriber education and awareness of PIM use among elderly individuals are warranted.
authors.affiliation: BSc, BScPharm, ACPR, is with the Pharmacy Department, The Ottawa Hospital-General Campus, Ottawa, Ontario.
authors.forename: Erin
authors.initials: E
authors.lastname: Francis
authors.affiliation: BScPharm, CGP, is with the Pharmacy Department, The Ottawa Hospital-Civic Campus, Ottawa, Ontario.
authors.forename: Derek
authors.initials: D
authors.lastname: Dyks
authors.affiliation: BSc, PharmD, ACPR, is with The Ottawa Hospital Research Institute and the Pharmacy Department, The Ottawa Hospital- General Campus, Ottawa, Ontario; the Faculty of Medicine, University of Ottawa, Ottawa, Ontario; and the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Kanji
keywords: falls; hospital admission; older adults; potentially inappropriate medications