Step 1 Summarize four selected and approved research articles from your literature search.

  1. List the inclusion and exclusion criteria used in the search (one paragraph).
    1. Include the terms used in the search and the filters used for search: date ranges, key words (if applicable), qualitative versus quantitative articles, and so on.
    2. Identify the search engine(s) used for the search (PubMed, CINAHL, EBSCO, UpToDate).                      
  2. Provide an appraisal/analysis of the articles.
    Describe the research components valuable to the creditability of the studies (one to two paragraphs per article).

    1. Summary of overall article as it pertains to proposed project
      1. Number of participants/sample size
      2. What was done in the study
      3. Validity/reliability of the pre- and post-assessment tool(s), if applicable
      4. Findings of the study
      5. Any other pertinent information


Association of benzodiazepine and Z-drug
use with the risk of hospitalisation for fall-
related injuries among older people: a
nationwide nested case–control study in
Nan-Wen Yu1,2, Pei-Jung Chen1, Hui-Ju Tsai3,4, Chih-Wan Huang1,2, Yu-Wen Chiu1,2, Wen-Ing Tsay5, Jui Hsu5

and Chia-Ming Chang1,2*


Background: Non-benzodiazepine hypnotics (Z-drugs) are advocated to be safer than benzodiazepines (BZDs). This
study comprehensively investigated the association of BZD and Z-drug usage with the risk of hospitalisation for
fall-related injuries in older people.

Methods: This study used the Taiwan National Health Insurance Database with a nested matched case-control
design. We identified 2238 elderly patients who had been hospitalised for fall-related injuries between 2003 and
2012. They were individually matched (1:4) with a comparison group by age, sex, and index year. Conditional
logistic regression was used to determine independent effects of drug characteristics (type of exposure, dosage,
half-life, and polypharmacy) on older people.

Results: Older people hospitalisation for fall-related injuries were significantly associated with current use of BZDs
(adjusted odds ratio [AOR] = 1.32, 95% confidential interval [CI] = 1.17–1.50) and Z-drugs (AOR = 1.24, 95%CI = 1.
05–1.48). At all dose levels of BZDs, high dose levels of Z-drugs, long-acting BZD, and short-acting BZD use were all
significantly increased the risk of fall-related injuries requiring hospitalisation. Polypharmacy, the use of two or more
kinds of BZDs, one kind of BZD plus Z-drugs and two or more kinds of BZDs plus Z-drugs, also significantly increased
the risk (AOR = 1.61, 95% CI = 1.38–1.89; AOR = 1.65, 95% CI = 1.08–2.50, and AOR = 1.58, 95% CI = 1.21–2.07).

Conclusions: Different dose levels and half-lives of BZDs, a high dose of Z-drugs, and polypharmacy with
BZDs and Z-drugs were associated with an increased risk of fall-related injury requiring hospitalisation in
older people. Physicians should balance the risks and benefits when prescribing these drug regimens to
older people considering the risk of falls.

Keywords: Benzodiazepine, Z-drugs, Older people, Fall, Hospitalisation

* Correspondence: [email protected]
1Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and
Chang Gung University, Taoyuan, Taiwan
2Division of Rehabilitation & Community Psychiatry, Department of
Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan
Full list of author information is available at the end of the article

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (

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Deprescribing in the Older Patient: A Narrative Review of Challenges and

Authors: Harry Wu, Lisa Kouladjian O’Donnell, Kenji Fujita, Nashwa Masnoon and Sarah N. Hilmer
Date: July 31, 2021

From: International Journal of General Medicine(Vol. 14)
Publisher: Dove Medical Press Limited

Document Type: Article
Length: 6,443 words

Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of
adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant
public and professional interest in the role of deprescribing in reducing medication-related harms in older people.
We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the
challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of
using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing
research and practice. Deprescribing is an established management strategy to minimize polypharmacy and
potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric
outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on
the success of deprescribing interventions in research and practice. Management strategies that target all levels
of the healthcare system are required to overcome these challenges. Future studies may consider large
multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on
clinical outcomes.

Keywords: deprescribing, polypharmacy, geriatric,

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Clinical Interventions in Aging 2016:11 1253–1261

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Open Access Full Text Article

geriatric falls in the context of a hospital fall
prevention program: delirium, low body mass
index, and other risk factors

Katarzyna Mazur
Krzysztof Wilczyński
Jan szewieczek
Department of geriatrics, school of
health sciences in Katowice, Medical
University of silesia, Katowice, Poland

Background: Inpatient geriatric falls are a frequent complication of hospital care that results
in significant morbidity and mortality.

Objective: Evaluate factors associated with falls in geriatric inpatients after implementation
of the fall prevention program.

Methods: Prospective observational study comprised of 788 consecutive patients aged
79.5±7.6 years (χ− ± standard deviation) (66% women and 34% men) admitted to the subacute
geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination,

Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed.

Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized

into low, moderate, or high fall risk groups after clinical and functional assessment.

Results: About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and
high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased

fall probability was associated with age $76 years (P,0.001), body mass index (BMI) ,23.5

(P=0.007), Mini-Mental State Examination ,20 (P=0.004), Barthel Index ,65 (P=0.002),
hemoglobin ,7.69 mmol/L (P=0.017), serum protein ,70 g/L (P=0.008), albumin ,32 g/L
(P=0.001), and calcium level ,2.27 mmol/L. Four independent factors associated with fall risk
were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33;
95% confidence interval [95% CI] =2.76–19.49; P,0.001), history of falls (OR =2.55; 95%
CI =1.05–6.19

E500 CMAJ | APRIL 23, 2018 | VOLUME 190 | ISSUE 16 © 2018 Joule Inc. or its licensors

T he rate of opioid prescription for pain treatment has been increasing rapidly in North America in the past 20 years.1,2 For example, between 2001 and 2010, the per-
centage of patients receiving an opioid prescription during an
emergency department visit increased from 20.8% to 31%, a rela-
tive increase of 49%.1 Furthermore, the frequency of opioid pre-
scription increases with age.3

Opioids are sometimes necessary to treat acute pain, but they
can cause adverse effects, especially in the older population.4–6 It
has been found that drugs that affect the central nervous system
(e.g., drugs that cause sedation and dizziness) can increase the
risk of falling.7 Falls are frequent among people aged 65 years and
older (28%–35% fall each year)8 and constitute a leading cause of
injuries, hospital admissions and deaths among older people.9

Several studies have established an association between opi-
oid use and risk of falls or fractures in the older population.10–17 In
a nested case–control study, Moden and colleagues found that
using psychotropic drugs increased the risk of falls in older peo-
ple. Specifically, opioid use was more likely to induce a fall within

the next week (odds ratio [OR] = 6.07 for men and 5.16 for
women).13 In another study in a level-1 trauma centre with
patients of all ages, falls were more prevalent among patients
who had used opioids in the month preceding the trauma com-
pared with patients who had not (32.8% v. 22.0%).10 Further-
more, Söderberg and colleagues found that taking opioids
increases the likelihood of an imminent fall-related injury.12 For
example, having a prescription of opioids filled 1 week before the
fall is associated with an OR of 5.14 of falling compared with an
OR of 1.23 when the prescription is filled within 4 weeks of the
fall. However, other studies did not find a significant association
between opioid use and falls,18–20 and none examined this in
severely injured older people who are at higher risk of death.

The objectives of the study were to examine the association
between recent opioid use and the risk, as well as the clinical
outcomes, of fall-related injury in a large trauma population of
older adults. We hypothesized that fall-related injuries will be
more likely to occur with recent opioid use than injuries that
occur from other mechanisms.


Recent opioid use and fall-related injury among
older patients with trauma
Raoul Daoust MD MSc, Jean Paquet PhD, Lynne Moore PhD, Marcel Émond MD MSc, Sophie Gosselin MD,
Gilles Lavigne DMD PhD, Manon Choinière PhD, Aline Boulanger MD, Jean-Marc Mac-Thiong MD,
Jean-Marc Chauny MD MSc

n Cite as: CMAJ 2018 April 23;190:E500-6. doi: 10.1503/cmaj.171286

BACKGROUND: Evidence for an associa-
tion between opi

Recent opioid use and fall-related injury among older patients with trauma

Daoust, R., Paquet, J., Moore, L., Emond, M., Gosselin, S., Lavigne, G., Choiniere, M., Boulanger, A., Mac-Thiong, J. M., & Chauny, J.-M. (2018). Recent opioid use and fall-related injury among older patients with trauma. CMAJ: Canadian Medical Association Journal, 190(16), E500+.

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

Mazur, K., Wilczyhski, K., & Szewieczek, J. (2016). Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clinical Interventions in Aging, 11, 1253+.

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu, H., O’Donnell, L. K., Fujita, K., Masnoon, N., & Hilmer, S. N. (2021). Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions. International Journal of General Medicine, 14, 3793+.

Association of benzodiazepine and Z-drug use with the risk of hospitalization for fall-related injuries among older people: a nationwide nested case-control study in Taiwan

Yu, N.-W., Chen, P.-J., Tsai, H.-J., Huang, C.-W., Chiu, Y.-W., Tsay, W.-I., Hsu, J., & Chang, C.-M. (2017). Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case-control study in Taiwan. BMC Geriatrics, 17(1).