Implementation of a De-prescribing Medication Protocol to Evaluate Falls in Older Adults

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Abstract The proposed study will engage health care professionals (HCPs) to screen older adult patients at risk for falls. We will use the Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit so all HCPs can identify patients at risk for falling within outpatient primary care clinics within the UNC Health Care System. These patients will be identified using an electronic health record (EHR) from UNC Health Care. Patients who are 65 years of age or older and taking either one opioid or benzodiazepine (BZD) will be included in the study. These clinics will engage the identified patients at risk for falls, educate patients on the risk of falls and injury posed by their opioid or BZD medication(s), and implement a de-prescribing medication protocol with a multidisciplinary team. Prior research indicates that opioid and benzodiazepine medications are among the most difficult to manage and least likely to result in a change. Given the country's current opioid crisis, our new approach will focus on educating HCPs on how to employ a de- prescribing protocol for these medications in older adults at risk for falls, incorporating alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This proposed study will use a shared EHR to document answers to STEADI screening questions. We intend to create protocols specific to falls education as well as information about de-prescribing specific to BZDs and opioids, including alternate strategies for managing pain, insomnia, and/or anxiety. By using the EHR, we will be able to provide referral for fall prevention services beyond employing a de-prescribing protocol for opioid and BZD medications in older adults at risk for falls. We will be able to incorporate alternate (and multidisciplinary) treatment modalities and/or medications where warranted. This study will identify factors affecting the effectiveness, adoption, implementation, and maintenance of a de-prescribing program focused on BZDs and opioids with the intent of reducing falls. This will enable us to create guidelines for developing and implementing similar programs for other health systems across the United States.