Falls and Polypharmacy in a Rheumatology Rehabilitation Setting: The Importance of Rehabilitation and Medication Review
McDonough A, O’Reilly A, Mongey A
Department of Rheumatology, St. Vincent’s University Hospital
Due to our ageing population, it is anticipated that the rates of falls and the complications of falls will rise. Rheumatology patients are at higher risk due to their underlying diagnosis1 which also puts them at higher risk of the consequences of falls, such as osteoporotic fracture. Polypharmacy (defined as 5 or more medications) is another common contributing factor which can further increase this risk.
To collect data on patients admitted for rheumatology rehabilitation regarding polypharmacy and falls.
We obtained routine data on patients aged over 50 years who were admitted to Harold’s Cross rheumatology rehabilitation centre. Medication lists were reviewed and analysed for falls related medications. Details of patients falls and those requiring hospitalisation within the preceding year were also collected.
43 inpatients over a 6 week period were selected at random. The average number of medications per patient was 8 with 2.6 accounting for falls-related medications. 88% of patients were taking 5 or more medications. 46.5% were taking regular opioids, with 27.9% taking sedatives and 11.6% taking benzodiazepines, all of which are associated with a high falls risk2. 32.6% had fallen within the preceding year, with 21% of these requiring hospitalisation. This group represented an older cohort, with an average age of 74 years. They were taking more medications (average 9) and more falls related medications (average 3) than the cohort who had not fallen.
Given that up to 40% of falls are preventable1, it is vital to identify and address further risk factors for falls, in this already at risk rheumatology patient cohort. The interventions provided in the inpatient rheumatology setting, such as medication review, physiotherapy and occupational therapy are vital for identification of those at higher risk and for prevention of falls going forward.