237 Frequency of Discharge Prescriptions Known to Increase Fall Risk for Older Adults: Estimates of Incidence in the United States

Abstract

The Centers for Disease Control and Prevention estimate that 36 million older adults fall each year in the United States, and 32,000 die due to falls. Several classes of potentially inappropriate medications commonly prescribed at ED discharge are known to elevate fall risk, including opioids (Relative Risk 1.4), benzodiazepines (Odds Ratio (OR) 1.6), sedatives/hypnotics (OR 1.5), muscle relaxants (OR 1.3), and anticholinergic agents (OR 1.6). However, little research has been done to characterize the frequency of ED prescriptions of such medications. Our objective was to estimate the annual incidence of discharge prescriptions for medications known to increase fall risk for older adults in the United States. In a hypothesis-generating exercise, we also sought to describe visit characteristics associated with prescriptions for medications that increase fall risk so that we can tailor future work to reduce potentially harmful prescriptions. This was a descriptive, retrospective observational study of the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2019 dataset. We limited our analysis to patients age 65+ who were discharged without inpatient or observation admission. We categorized patients as having received at least one ED discharge prescription for a medication known to increase fall risk (opioid, benzodiazepine, sedative/hypnotic, muscle relaxant, and/or anticholinergic agent) versus those who did not. We also generated descriptive statistics for patients in both groups. The analysis was performed with Stata/MP version 17.0, and the iweight function was used to generate national estimates. Out of a sample of 16.9 million discharged patients age 65+, an estimated 2.3 million received a prescription for at least one medication that is known to increase fall risk. The most commonly prescribed classes of medications were: opioids (1.5 million), anticholingeric agents (323,000), muscle relaxants (269,000), benzodiazepines (153,000), and sedative/hypnotics (31,000). These estimates were generated from the following unweighted results: a sample size of 2,137 patients who met inclusion criteria, and 291 who received medications known to increase fall risk (176 opioid, 52 anticholinergic, 45 muscle relaxant, 14 benzodiazepine, and 4 sedative/hypnotic). Given the small sample size for the less common prescriptions, comparisons in the Table are done using pooled data for all patients with prescriptions of interest. Approximately 2.3 million older adults received prescriptions at the time of ED discharge for medications that are known to increase fall risk. The role that these prescriptions play in causing falls and other adverse health outcomes after ED discharge has not been thoroughly investigated.