High-risk medications pose serious safety risks to older adults, including increasing the risk of falls. Deprescribing potentially inappropriate medications (PIMs) in older adults who have experienced a fall is a key element of fall reduction strategies. However, continued use of PIMs in older adults is common, and clinicians may face substantial deprescribing barriers.
A study published on pubmed.ncbi.nlm.nih.gov was conducted to explore patient and clinician experiences with and perceptions of deprescribing PIMs in patients with a history of falls. The group led guided patient feedback sessions to explore deprescribing scenarios with patient stakeholders and conducted semi-structured interviews with primary care physicians (PCPs) to explore knowledge and awareness of fall risk guidelines, deprescribing experiences, and barriers and facilitators to deprescribing.
Physicians perceived deprescribing discussions as potentially contentious, even among patients with falls. Physicians reported varying comfort level with deprescribing strategies: some felt that the conversations might be better suited to others such as pharmacists, while others had well-planned negotiation strategies. Patients reported lack of clarity as to the reasons and goals of deprescribing and poor understanding of the seriousness of falls. Barriers to deprescribing include PCP trepidation about raising a contentious topic and insufficient patient awareness of the potential seriousness of falls. Findings suggested that there is a need for a multi-faceted, multi-level deprescribing approach with clinician training strategies, patient educational resources, and a focus on building trusting patient-clinician relationships.
A lot of meaningful research however we need to remember, we are the advocates for our residents. If you have a resident experiencing falls, do something about it, request a drug regimen review and weigh the risk/benefits of continuing specific medications. Often times it isn’t the first fall that results in a catastrophic injury but rather the second or third. Don’t wait for that to happen, be proactive, talk to your physicians, and circle back to the pharmacist; they are all a wealth of knowledge but may need a little nudge!
Stay well, mask up, and stay tuned!