title: Deprescribing medicines in the acute setting to reduce the risk of falls.
abstract: BACKGROUND
  Falls are a common cause of morbidity and hospitalisation in older people. Inappropriate prescribing and polypharmacy contribute to falls risk in elderly patients. This study's aim was to quantify the problem and find out if medication review in the hospital setting led to deprescribing of medicines associated with falls risk.
  
  
  METHODS
  Admissions records for elderly patients were examined to identify those whose presenting complaint included a fall. Inpatient medication charts, pharmaceutical care notes, medical notes and discharge summaries were examined to identify any falls-risk medicines from admission histories and to determine if any medication review took place, and whether or not changes were made as a result. In particular deprescribing and dose reduction details were analysed.
  
  
  RESULTS
  100 patients over 70 years old were admitted following a fall during the 2 months study period. The mean number of medicines on admission was 6.8 per patient with polypharmacy found in 62/100 (62%). One or more falls-risk medicine was found in 65/100 (65%) patients. Medicines review was carried out in 86/100 (86%) of patients, and 59/697 (8.5%) medicines were deprescribed. Pharmacist involvement in medication review led to a significant reduction in the number of falls-risk medicines per patient (p=0.002).
  
  
  CONCLUSIONS
  Inappropriate prescribing and polypharmacy are found frequently in elderly patients at admission following a fall. Comprehensive medicines reviews should be carried out in all such patients with the objective of deprescribing or reducing doses to minimise risk of harm. Involvement of a pharmacist improves the rate of reduction of falls-risk medicines.
authors.affiliation: Department of Pharmacy , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Marvin
authors.affiliation: Department of Pharmacy , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Ward
authors.affiliation: NIHR CLAHRC NWL , Imperial College London , London , UK.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Poots
authors.affiliation: Department of Pharmacy , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Heard
authors.affiliation: School of Medicine, Imperial College London , London , UK.
authors.forename: Arvind
authors.initials: A
authors.lastname: Rajagopalan
authors.affiliation: NIHR CLAHRC NWL, Imperial College London, London, UK; Institute of Pharmaceutical Sciences, King's College London, London, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Jubraj
keywords: CLINICAL PHARMACY; Falls; deprescribing; hospital; medication review; quality improvement