Few medication changes made for patients hospitalized for fall injury

'Missed opportunity' for review of treatments that raise risk of serious fall

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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People with Parkinson’s disease who are hospitalized for fractures due to falls or other traumatic injuries are not likely to stop being prescribed medications that can increase a fall risk, a study reports.

Findings were similar in patients hospitalized for other Parkinson’s-related reasons, like pneumonia or urinary tract infections.

Given the recent World Guidelines for Falls Prevention and Management for Older Adults, “our findings highlight a missed opportunity for a complete medication review and deprescribing to prevent recurrent serious injuries” in these patients, its researchers wrote.

The study, “Potentially inappropriate medications in older adults with Parkinson disease before and after hospitalization for injury,” which was published in Parkinsonism and Related Disorders.

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Parkinson’s patients often are using five or more treatments

Due to common Parkinson’s motor symptoms such as balance problems and gait freezing, people with the disease are at a high risk of falling, which can lead to broken bones, or fractures, and other injuries.

Patients often are given different combinations of Parkinson’s treatments to help manage the various facets of their disease, and they also may be treating for other conditions common to older adults. While disease therapies can be invaluable for controlling symptoms, some used in the management of Parkinson’s can lead to an increased risk of falls or injuries from falls.

Polypharmacy, the concurrent use of five or more medications, is common in Parkinson’s, the research team, mostly with the University of Pennsylvania’s medical school, wrote.

Theoretically, if a patient experiences a fall or injury, decreasing or stopping the use of medications tied to a fall risk may lower the likelihood of future injuries.

Scientists analyzed data collected by Medicare — the government program that provides health insurance to adults in the U.S. starting at age 65 — in order to assess how prescriptions change for people with Parkinson’s hospitalized due to a traumatic injury or other reason.

‘Negligible differences’ given to prescriptions after serious injury

Collected data covered 9,473 people with Parkinson’s who were hospitalized due to a fall or injury between 2013 and 2017. For comparison, the scientists also looked at data from 32,487 Parkinson’s patients hospitalized for reasons like an infection.

Prior to hospitalization, about two-thirds of patients in both groups were taking at least one medication that’s active in the brain and, as such, could increase a fall risk.

The researchers found that, at three months after hospitalization, there was a slight but statistically significant reduction in the use of these medicines for people hospitalized due to injury, compared with those hospitalized for other reasons. However, the difference between these groups was not significant at six or 12 months after hospital discharge.

Similarly, no difference between the two groups was seen in the use of potentially problematic therapies specifically aiming to address Parkinson’s motor or its nonmotor symptoms.

“We found clinically negligible differences in [potentially inappropriate medication] use among persons with [Parkinson’s] hospitalized for serious injury versus other diagnoses,” the researchers wrote.

A possible reason is that the “discontinuation of disease-specific medications were left to neurologists, who are currently not routinely involved in post hospitalization care,” they added.

Need for better review of potentially problematic Parkinson’s treatments

The researchers suggested that clinicians give a more thorough review to patients’ medications, so that any potentially problematic treatments can be stopped or reduced, helping to lower the risk of future injuries.

Results also showed a significantly lesser use of medicines that can lower bone density after a hospitalization for a traumatic injury, compared with hospitalization for other reasons. Since lower bone density can increase the risk of fractures, these findings “may signal a deprescribing in response to growing general knowledge about fracture risk and routine screening for bone mineral density,” the researchers wrote.

They stressed, however, that it’s impossible to draw firm conclusions about cause-and-effect from analyzed data.

This study looked at broad categories of medications, highlighting a need for future research to delve deeper into the effects of specific treatments, the researchers noted. It also used data collected nearly a decade ago, during the mid-2010s, so its findings may not be reflective of an increased awareness of these issues in recent years, they added.