Polypharmacy and Falls Risk in Older Adults Presenting to the Front Door

Abstract Background Falls are a leading cause of morbidity and hospitalisation in older adults. The world falls guidelines outline the approach to risk stratification, assessment, prevention and management of falls in this population (1). Comprehensive Geriatric Assessment (CGA) has been introduced to a Frailty at the Front Door (FFD) service in the Emergency Department (ED) of an Irish Model 3 hospital. This study investigates the association between anticholinergic burden, polypharmacy (defined as ≥5 medications), Falls Risk Increasing Drgs (FRIDs) and falls risk in older adults assessed by this service. Methods A retrospective cohort study was conducted on adults aged ≥65 years assessed by the FFD service. The Falls Risk Stratification Algorithm (FRSA) was used to stratified cases into high or low/intermediate falls risk (1). Data collected included: number of medications, anticholinergic burden (ACB) score, number of fall-risk increasing drugs (FRIDs), Clinical Frailty Scale (CFS) score, 4AT and age. Binary logistic regression was used to identify independent predictors of high falls risk. Results A total of 136 patients (103 high risk, 33 low/intermediate risk) were analysed. High-risk patients had a significantly higher mean ACB score (3.12 vs 2.27, p=0.02), were slightly older (mean age: 82.8 vs 81.8 years, p=0.536), and had a higher medication burden (10.1 vs 9.2, p=0.109). The mean number of FRIDs was similar in both groups (3.14 vs. 3.09, p=0.725). The ACB score was a significant predictor of high falls risk (OR=1.36, 95% CI:1.02–1.83; p=0.039). Polypharmacy and FRIDs number were not significant predictors in this cohort. Conclusion High falls risk is prevalent in Older adults attending the ED and the Frailty at the Front Door service plays a vital role in identifying and addressing polypharmacy and anticholinergic burden. Reference 1. Montero-Odasso, M. et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022;51:1–36.