2026 Southeastern Residency Conference

Introduction:    
Some of the most prescribed medications in the elderly population have potent anticholinergic properties, which are associated with potentially harmful side effects, such as an increased risk of falls. In addition, many elderly patients are on potentially inappropriate medications as defined by the Beers criteria, many of which can also increase fall risk. Pharmacists can play a pivotal role in preventing inpatient falls by proactively identifying patients taking potentially inappropriate medications and making recommendations related to de-prescribing or medication optimization. The objective of this study is to investigate if a causal relationship exists between inpatient falls and medication usage. 
Methods:  
This is a retrospective case-controlled study of adult patients aged 65 years or older admitted to The University of Tennessee Medical Center from January 2023 to May 2025. Patients were separated into two groups: the fall group, which included patients aged 65 years or older who had experienced an inpatient fall (as identified by ICD-10 codes for inpatient falls), and the control group, which included patients aged 65 years or older who had not experienced an inpatient fall. Patients were excluded if they were under 65 years old. The Anticholinergic Burden Score and the Beers Criteria scoring systems were utilized to assess the total number of potentially inappropriate medications the patients were taking at admission, during their hospital stay, and at discharge. The primary outcome is the median score on each scoring system at each time point: admission, during their hospital stay, and on discharge. Secondary outcomes are length of stay and discharge location. 
Results: 
A total of 310 participants met the inclusion criteria. Baseline characteristics were similar between groups except for a higher prevalence of atrial fibrillation in the no-fall group (P = 0.004). Both measures of potentially inappropriate medication exposure were significantly higher in patients who experienced a fall. Median Anticholinergic Burden scores were 4 vs 2 (P < 0.0001), and median Beers Criteria scores were 7 vs 5 (P < 0.0001) in the fall and no-fall groups, respectively. Despite no difference in admissions scores, the change in both metrics from admission to maximum inpatient values were significantly greater in the fall group (P < 0.0001). Patients who fell had a longer median length of stay (8 vs 4 days, P < 0.0001) and were more frequently discharged to skilled nursing facilities (P < 0.0001). A post-hoc analysis was conducted regarding past medical history for atrial fibrillation and Parkinson's disease, as they were significant or marginally non-significant, respectively. Each 1-point increase in Anticholinergic Burden Score increased fall risk by 26.9%, and each 1-point increase in Beers Criteria Score increased fall risk by 14.3% among patients with atrial fibrillation or Parkinson's disease. 
Conclusion: 
Patients who experienced an inpatient fall had significantly higher maximum Anticholinergic Burden and Beers Criteria scores than those who did not fall. Falls were also associated with longer hospital stays and a greater likelihood of discharge to a skilled nursing facility. Medication risk scores increased from admission through the time of the fall, suggesting an opportunity to improve inpatient medication optimization to prevent falls. Future research should evaluate high-risk medication combinations and dose-related effects within the Anticholinergic Burden and Beers Criteria to better guide prescribing for high-risk hospitalized patients.