Age-related pharmacovigilance perspectives

Abstract

Drug-related falls are of particular concern in older persons and lead to an increase in morbidity and mortality. Strategies to identify risk of drug-related falls could contribute to optimize patient care. This aim of the research was to apply pharmacovigilance processes in clinical pharmacy practice within a patient-centric approach and to reduce drug-related falls for older people through medication risk assessment. The methodology consisted of a four-stage design: (i) A literature scoping exercise to identify fall-risk assessment tools (FRATs); (ii) a pre-intervention study where an identified FRAT was applied retrospectively to evaluate the extent of deprescribing in 55 older patients at a rehabilitation hospital with a history of falls from January to July 2021, using pharmacy patient profiles as a data source; (iii) a presentation of the selected FRAT tool and findings by the researcher to the clinical pharmacists at the rehabilitation hospital so that FRAT was to be used in their daily deprescribing activities; (iv) a post-intervention study starting one month after introducing the selected FRAT tool to the pharmacists, for assessment of the degree of deprescribing in 58 older patients with a history of falls from October 2021 to January 2022. A model for medication risk management for older people was developed. Literature review (n=88) classified five multifactorial tools and three medication-based tools. The STOPPFall (Seppala et al., 2020) tool from the medication-based category was chosen. From the pre-intervention results, the average age of patients was 81 years (65% females). Hypertension (n=45), diabetes (n=25) and cardiovascular diseases (n=25) were the most prevalent comorbidities. Antidepressants (n=35), diuretics (n=34), opioids (n=31), and benzodiazepines (n=23) were the most frequent fall risk-increasing drugs (FRIDs) prescribed (N=162). Significant deprescription rates were evident for opioids (97%, p<0.01) and benzodiazepines (70%, p=0.030). Diuretics (47%), antipsychotics (46%), and antidepressants (37%) showed lower deprescription rates. During the intervention, 9 pharmacists participated who were informed about STOPPFall and encouraged to apply the tool in practice. The post-intervention resulted in an average age of 79 years (71% females). The most common chronic conditions were cardiovascular diseases (n=40), hypertension (n=40), and diabetes (n=23). Diuretics (n=41), opioids (n=39), and antidepressants (n=26) were the most prescribed FRIDs (N=181). Opioids (97%, p<0.01) and antipsychotics (67%, p=0.027) were significantly deprescribed. Lower deprescription rates were observed for benzodiazepines (53%), antidepressants (31%), and diuretics (27%). The intervention indicated that the majority of the deprescription rate did not significantly differ when comparing the pre- and post-analyses. A model targeting deprescribing as a pharmacist’s pharmacovigilance task in a multidisciplinary approach that must be embedded in a patient centric system was designed. This research resulted in the usage of the chosen medication-based fall risk assessment tool within the KGH pharmacy department to assess the range of deprescribing for older patients’ high risk of falls and the model was developed as part of the medication risk management.