Prescribing patterns of fall-risk-increasing and hypotension- inducing drugs in older emergency department patients: A Cross-sectional study

Abstract

Objectives: Older adults are frequently exposed to fall-risk-increasing drugs (FRIDs) and orthostatic hypotension-inducing drugs (OHDs), which significantly elevate the risk of adverse outcomes. However, evidence on prescribing patterns of these medications in emergency department (ED) settings, especially in the Middle East, remains limited. This study aimed to investigate the prescribing patterns of FRIDs and OHDs among older ED patients and to identify factors assocaited with thier prescription in ED setting. Methods: This cross-sectional study analyzed retrospecctivly the electronic health records of patients aged ≥ 65 years who visited the ED of a tertiary hospital in Saudi Arabia between January 2020 and December 2021. FRIDs and OHDs were identified using established classification criteria. To estimate one year mortality risk, the Charlson Comorbity Index (CCI) was calculated and documented. Logistic regression models were used to assess associations between patient characteristics and FRIDs/OHDs prescription and result were presented as adjusted odds ratio (OR) and corresponding 95% confidence interval (95%CI). Results: Among 5441 patients, 22% of patients were prescribed OHDs and 15% received FRIDs. Opioids were the most common FRIDs; calcium channel blockers and beta-blockers were the most frequent OHDs. FRID prescribing was significantly higher among females and was associated with a higher ACB score (OR = 1.9; 95%CI 1.8:2.1). OHD prescribing was associated with higher CCI scores (OR = 1.47; 95%CI 1.41:1.54). Conclusion: The high prevalence of FRID and OHD prescribing highlights the need for pharmacist-led medication reviews and incorporation of validated risk assessment tools into ED workflows to reduce fall risk in older adults.