Deprescribing Opportunities May be Missed in Patients With PD Hospitalized for Falls

Patterns of potentially inappropriate medication use after hospitalization were similar among older adults with Parkinson disease (PD) who were hospitalized for serious injury, such as fall-related fractures, compared with those hospitalized for other reasons, according to study results published in Parkinsonism & Related Disorders.

“Prescription medications represent a major modifiable factor for fall risk and fall-related fractures in the older adult population,” wrote corresponding author Allison W. Willis, MD, MS, University of Pennsylvania Perelman School of Medicine, Philadelphia, and study coauthors. “Previous studies have shown no or modest change in the prescribing of central nervous system (CNS)-active medications associated with falls or of medications that reduce bone density following a fall-related injury. These studies did not include large numbers of PD patients, who represent a potentially more vulnerable population.”

To better inform the care of older adults with PD, researchers conducted a quasi-experimental difference-in-difference study using Medicare data for the years 2013 through 2017. The analysis included 9473 beneficiaries with PD hospitalized for serious injury who were matched with 32487 beneficiaries with PD hospitalized for noninjury reasons, including septicemia, urinary tract infection, or pneumonia.

Researchers looked at mean standardized daily doses of potentially inappropriate medications in several categories before and at 3, 6, and 12 months after hospitalization. Changes in mean standardized daily doses were compared between patients hospitalized for injury and those hospitalized for other reasons.

After hospitalization, potentially inappropriate medications were stopped or doses were reduced in both the injury and noninjury groups, according to the study.

Nevertheless, with the exception for the CNS-active potentially inappropriate medications at 3 months after hospitalization and for medications that reduce bone mineral density at all timepoints, changes in mean standardized daily doses did not differ between groups, the study found. This included PD motor symptom potentially inappropriate medications, PD nonmotor symptom potentially inappropriate medications, and CNS-active potentially inappropriate medications at post-hospitalization timepoints other than 3 months.

“Similar patterns of potentially inappropriate medications among persons with PD after hospitalization for serious injury versus for other reasons may represent a missed opportunity to deprescribe high-risk medications during care transitions,” researchers advised.

Reference

Pham Nguyen TP, Gray SL, Newcomb CW, et al. Potentially inappropriate medications in older adults with Parkinson disease before and after hospitalization for injury. Parkinsonism Relat Disord. Published online August 6, 2023. doi:10.1016/j.parkreldis.2023.105793