Fall-Risk-Increasing Drugs: an European statement

by | Literature news

Seppala LJ, van der Velde N, Masud T et al.

Drugs Aging 2019;36:299-307
Link to Pubmed / Journal

Published October 19, 2020

Frailty.net review by Gérard Bozet, MD
Posted December 9, 2020

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor.

Falls with and without injuries in elderly persons commonly have multiple causes. Exposure to drugs does contribute to these causes. Therefore, complete assessment and evaluation of prescription and over the counter drugs are essential parts of fall-prevention concepts. Frail elderly persons frequently treated with several medications are particularly predisposed to adverse drug effects which may increase the risk of falling.

The European Geriatric Medicine Society (EuGMS) Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs) was founded in 2017.

The objectives of the groups are:

  • to update knowledge related to fall-risk-increasing drugs (FRIDs).
  • to disseminate knowledge on FRIDs and FRIDs withdrawal to health care workers, students and the older population at risk and thus lessen the use of unnecessary FRIDs in older persons at risk.
  • to develop drug withdrawal interventions that are personalised and effective, and
  • to harmonise practice on this topic across Europe.

In this statement, the The EuGMS Task and Finish group on FRIDs, in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. Steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

The authors advocate more attention to dissemination of knowledge regarding FRIDs, increased insight, and improved practice, including the following:

  • encouraging systematic judicious deprescribing by including the following steps: recognising a possible indication for the medication, searching for a safer alternative, performing shared decision making, and monitoring for symptoms after stopping the FRID,
  • disseminating knowledge to healthcare workers, healthcare students, and the older population, which could enable a more active role for older individuals in shared decision making.

    • A European FRIDs list should be created to be used as a fall-prevention tool. Finally, the authors recommend to increase knowledge about the risk of falls associated with therapeutic classes and individual medications through well-designed observational studies and RCTs.

    Reference(s)

    Seppala LJ, van der Velde N, Masud T, et al. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Drugs Aging 2019;36:299-307.

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