Table 1.
Observational Study Characteristics and Main Results
| Author, Year, Country | Design | No. of Subjects (Mean Age, y) | Setting/Sample Description | Timing of FRID Use | Main Results |
|---|---|---|---|---|---|
| Studies evaluating FRID use at admission vs time point after discharge | |||||
| Benuza-Sola,15 2018, Spain | Prospective cohort, single site | 252 (82) | Hospital, admitted for fall-related fracture | T1: admission T2: 1 mo postfracture | No significant difference in mean number of FRIDs per subject from T1 to T2: 3.1 ± 1.9 vs 3.4 ±2 (P = .099) For FRID subgroups, from T1 to T2, a significant increase in mean number of FRIDs per patient was noted for hypnotics (0.266 ± 0.469 vs 0.389 ± 0.520; P = .003) and antidepressants (0.468 ± 0.640 vs 0.571 ± 0.696; P = .042) |
| Sjöberg,21 2010, Sweden | Prospective, single site | 100 (86) | Hospital, underwent surgery for hip fracture | T1: admission T2: discharge T3: 6 mo postdischarge | FRID use increased from T1 (93% of participants) to T2 (100% of participants) (P = .01) No significant change in FRID use from T1 (93%) to T3 (94%) (P = .41) |
| Studies evaluating FRID use at admission vs discharge | |||||
| Bennett,14 2014, Australia | Prospective cohort, single site | 204 (80.5) | Hospital, admitted for fall | T1: admission T2: discharge | No change in mean FRID use per patient from T1 (2.5 ± 2.1) to T2 (2.5 ± 1.9) (P value not reported) |
| Francis,16 2014, Canada | Retrospective convenience sample, single site | 148 (82) | Hospital, admitted for fall and taking at least one PIM | T1: admission T2: discharge | From T1 to T2, 27% of patients had dosage reduction or discontinuation of PIM (P < .001); 16% had greater number or increased dose of PIM (P value not reported) Mean number of PIMs decreased from 1.6 ± 0.8 to 1.4 ± 0.9 between T1 and T2 (P = .03) Benzodiazepines had highest rate of discontinuation/dosage reduction (26% of patients on benzodiazepine had discontinuation and 14% had dosage reduction between T1 and T2 [P values not reported]); antipsychotics were the most frequently added class, with 9% of patients having new prescription between T1 and T2 (P value not reported) |
| Marvin,19 2017, United Kingdom | Prospective cohort, single site | 100 (85) | Hospital, admitted for fall | T1: admission T2: discharge | Number of patients on ≥1 FRID at T1 vs T2: 65 vs 60 (P value not reported) Significant reduction in total number of FRIDs among all patients from T1 to T2 (112 vs 91; P = .004) Mean FRIDs for patients undergoing review (N = 82): 1.19 (T1) vs 0.94 (T2) (P value not reported) Decrease in mean FRIDs for patients undergoing review with pharmacist (N = 45): 1.44 (T1) vs 0.91 (T2) (P = .002) |
| Studies evaluating FRID use via pharmacy claims before admission and after discharge | |||||
| Hill-Taylor,17 2016, Canada | Retrospective cohort, Nova Scotia insurer | 1789 (81.6) | Fall-related hospitalization and prescription for zopiclone or benzodiazepine in T1 | T1: within 100 d preadmission T2: within 100 d postdischarge | Benzodiazepine use continued in 74.2% of subjects between T1 and T2 Long-acting benzodiazepine exposure decreased from T1 to T2: 6.6% to 5.03%; relative reduction = 23.8% (95% Cl = 0.5%−42.6%); absolute reduction = 1.57% (95% Cl = 0.03%−3.10%) |
| Kragh,18 2011, Sweden | Retrospective cohort, Swedish county | 2043 (83) | Experienced hip fracture | T1: within 6 mo before hip fracture T2: within 6 mo after hip fracture | From T1 to T2, use of all FRIDs increased significantly (P < .001), with percentage of patients treated with FRIDs increasing from 67.7% to 97.7% Opioids had largest increase between T1 and T2 (21.1% to 73.6%) |
| McMahon,20 2014, Ireland | Before-and-after design, single site | 1016 (82.7) | ED, admitted for fall | T1: within 12 mo before fall T2: within 12 mo after fall | No significant change in prevalence of PIMs using STOPP30 criteriaa: 42.2% (T1) vs 42.9% (T2) (P = .67) No significant change in prevalence of PIMs using STOPP33 criteriab: 53.1% (T1) vs 53.7% (T2) (P = .64) No significant change in prevalence of PIMs from AGS Beers Criteria®c: 44.0% (T1) vs 41.5% (T2) (P = .125) |
| Trenaman,22 2018, Canada | Before-and-after design, Nova Scotia insurer | 585 | Fall-related hospitalization and prescription for antipsychotic in T1 | T1: within 100 d preadmission T2: within 100 d postdischarge | 76.5% of participants surviving hospitalization had an antipsychotic drug dispensed at T2 |
| Walsh,23 2019, Ireland | Before-and-after design, 44 general practices | 927 (81.2) | Hospitalization due to fall, fracture, or syncope | T1: within 12 mo prehospitalization T2: within 12 mo posthospitalization | Significant increase in sedatived use from T1 (40% of participants) to T2 (45% of participants) (P < .01) No change in vasodilator use from T1 (54% of participants) to T2 (54% of participants) (P = .70) |
Abbreviations: CI, confidence interval; ED, emergency department; FRID, fall risk–increasing drug; PIM, potentially inappropriate medication; STOPP, screening tool of older persons’ prescriptions; T1, time 1; T2, time 2.
a
STOPP30: 30 STOPP criteria applied.
b
STOPP33: STOPP criteria plus three additional criteria.
c
Beers Criteria® included α blockers, doxazosin, tertiary tricyclic antidepressants, first- and second-generation antipsychotics (in dementia), benzodiazepines (short, intermediate, and long acting), nonbenzodiazepine hypnotics for longer than 90 days, and non–cyclooxygenase-selective nonsteroidal anti-inflammatory drug chronic use for longer than 3 months.
d
Sedatives included benzodiazepines, Z drugs (nonbenzodiazepine hypnotics), and antipsychotics