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March 2021

Prescribing decision aid cuts falls in elderly

Greater scrutiny in prescribing for elderly patients may have prevented 26,000 falls in a single year, according to new analysis by Kent Surrey Sussex Academic Health Science Network (KSS AHSN).

The review examined the benefits of healthcare professionals using a prescribing decision support technology to avoid risky prescription of anticholinergic drugs in elderly patients with dementia or a history of falls.

The analysis for 2019-20 calculated that 26,000 falls may have been prevented after it compared the number of times primary care prescribers accepted messages from the OptimiseRx solution, against the assessed risk of a fall to the individual patient.

A third of elderly people in the UK are expected to suffer one fall a year, with half of those having two or more falls. Currently hip fractures account for 1.8 million bed days nationally, costing the NHS £1.1 billion per year.

Ian Mylon, Head of Analytics Delivery, KSS AHSN, said: ‘Our initial analysis of specific messages presented to prescribers relating to anticholinergic drugs shows some potentially very positive outcomes for the management and reduction of a serious clinical issue for elderly people.’

Anticholinergic drugs are commonly used to treat a range of conditions including irritable bowel syndrome, excessive drooling, and urinary incontinence. They do this by blocking the neurotransmitter acetylcholine, which controls a wide range of functions, from digestion and blood pressure, to muscle function and memory and attention.

However, other drug classes including antidepressants, antipsychotics, and antihistamines can inadvertently affect the acetylcholine system and increase the ‘anticholinergic burden’ for patients, leading to a higher risk of adverse effects, including blurred vision, constipation, dry mouth, disorientation and even delirium and falls.

Practice Nurse 2021;51(2):online only