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Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.

Publication ,  Journal Article
Pavon, JM; Davidson, S; Sloane, R; Pepin, M; Bryan, W; Bailey, J; Igwe, I; Colon-Emeric, C
Published in: J Am Geriatr Soc
February 2024

BACKGROUND: Falls are the most common medication-related safety event in older adults. Deprescribing fall risk-increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden and falls-related acute visits over 1 year. METHODS: The Falls Assessment of Medications in the Elderly (FAME) Program is a pilot deprescribing program designed to improve medication safety in Veterans aged ≥65, screening positive for high fall risk at the Durham Veterans Affairs Health Care System. Central case finding and electronic case reviews with deprescribing recommendations were completed by an interdisciplinary team, forwarded to prescribers for approval, then implemented during follow-up telephone visits by FAME team. Primary outcome was change in FRID burden calculated by modified Drug Burden Index (DBI) at 1 year and an exploratory outcome was 1-year fall-related acute visits. RESULTS: Overall, 472 patients (236 intervention cases, 236 matched controls) were included in the study. Of the 236 patients receiving a FAME deprescribing plan, 147 had recommendations approved by prescriber and patient. In the intention-to-treat analysis, the 1-year change in modified DBI was -0.15 (95% CI -0.23, -0.08) in the intervention cohort and -0.11 (-0.21, -0.00) in the matched control cohort (p = 0.47). The odds of increasing DBI by a clinically important threshold of 0.5 was significantly lower in the FAME cohort (OR 0.37, 0.21, 0.66). Fall-related acute events occurred in 6.3% of patients in the intervention group versus 11.0% in control patients over a one-year period (p = 0.10). CONCLUSIONS: The program was associated with a significantly lower odds of further increasing FRID burden at 1 year compared to matched controls. An electronic case review and telephone counseling program has the potential to reduce drug-related falls in high-risk older adults.

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Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

February 2024

Volume

72

Issue

2

Start / End Page

433 / 443

Location

United States

Related Subject Headings

  • Veterans
  • Polypharmacy
  • Humans
  • Geriatrics
  • Electronics
  • Deprescriptions
  • Aged
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
 

Citation

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ICMJE
MLA
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Pavon, J. M., Davidson, S., Sloane, R., Pepin, M., Bryan, W., Bailey, J., … Colon-Emeric, C. (2024). Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls. J Am Geriatr Soc, 72(2), 433–443. https://doi.org/10.1111/jgs.18650
Pavon, Juliessa M., Spencer Davidson, Richard Sloane, Marc Pepin, William Bryan, Janine Bailey, Ivuoma Igwe, and Cathleen Colon-Emeric. “Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.J Am Geriatr Soc 72, no. 2 (February 2024): 433–43. https://doi.org/10.1111/jgs.18650.
Pavon JM, Davidson S, Sloane R, Pepin M, Bryan W, Bailey J, et al. Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls. J Am Geriatr Soc. 2024 Feb;72(2):433–43.
Pavon, Juliessa M., et al. “Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls.J Am Geriatr Soc, vol. 72, no. 2, Feb. 2024, pp. 433–43. Pubmed, doi:10.1111/jgs.18650.
Pavon JM, Davidson S, Sloane R, Pepin M, Bryan W, Bailey J, Igwe I, Colon-Emeric C. Deprescribing electronic case reviews for older veterans at risk for falls: Effects on drug burden and falls. J Am Geriatr Soc. 2024 Feb;72(2):433–443.
Journal cover image

Published In

J Am Geriatr Soc

DOI

EISSN

1532-5415

Publication Date

February 2024

Volume

72

Issue

2

Start / End Page

433 / 443

Location

United States

Related Subject Headings

  • Veterans
  • Polypharmacy
  • Humans
  • Geriatrics
  • Electronics
  • Deprescriptions
  • Aged
  • 52 Psychology
  • 42 Health sciences
  • 32 Biomedical and clinical sciences