Watch your step: Helping patients avoid falls


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Falls are a very serious and growing problem among America’s senior adults. One out of three older adults will fall every year. This adds up to around $34 billion dollars each year in fall-related costs for emergency department visits, hospitalizations, surgeries to fix broken bones, follow-up visits, and physical therapy.


Medication risk


“One of the major risk factors for falls is medications,” said Kathleen Cameron, Senior Director of the National Council on Aging’s (NCOA) National Falls Prevention Resource Center. “Pharmacists are in a great position to help identify older adults who are at risk for falls and educate older people and their caregivers about things they can do to reduce the risk of falling.”


“Falls are preventable, they are predictable,” Cameron said in an interview with Pharmacy Today. “Although there are several risk factors, medications—both the number of medications and types of medications an older person may be taking—are contributing factors.”


Therapy changes


Medications’ adverse effects can also put older patients at risk for falls. “A lot of medications have common side effects like lowering blood pressure, or they may cause sleepiness and drowsiness during the daytime,” said Cameron, who is also a pharmacist. 


“Even when medications are taken at night, they may cause residual hangover effects the next day that can make some people sleepy and at risk for falls.” Other medications may impair balance and gait or cause muscle weakness or delirium. 


“Pharmacists are the drug experts and are familiar with the side effect profile of medications that increase the risk for falling,” Cameron told Today. “This is where the pharmacist plays a great role in identifying someone who is at risk for falls based on their medication profile.”


Safer alternatives


Pharmacists should pay particular attention to medications’ adverse effects when counseling patients with chronic conditions. Often these patients are taking multiple medications. “Pharmacists should review every medication a patient is taking,” said Cameron. “Maybe a patient was only taking a sleeping pill because a spouse died and was having difficulty falling asleep as a result of grief, but that was 3 years ago.”


She noted that pharmacists should make recommendations for safer medications that have fewer adverse effects. 


Education about falls


Although medication is an important risk factor for falls, pharmacists should talk to patients about nonmedication risk factors as well, such as getting their vision and hearing checked regularly. 


“If someone comes into the pharmacy and seems unsteady on their feet, perhaps someone with arthritis, Parkinson’s Disease, stroke; or if they are on an antidepressant medication, tell them to talk to their doctor about what they can do to reduce their risk for falls,” said Cameron.


Pharmacists can also refer patients to evidence-based programs for fall prevention or suggest local physical or occupational therapists.


Pharmacist toolkit


Cameron and her team at NCOA are currently collaborating with the American Society of Consultant Pharmacists to develop a toolkit on falls prevention for pharmacists. “The toolkit will include the tools pharmacists need to do falls risk assessment and to make proper recommendations to physicians for changes in medication therapy,” said Cameron. 


The toolkit also helps pharmacists identify products that should be stocked in the pharmacy, such as the best types of canes, walkers, and other devices. Cameron anticipates that the toolkit will be available in late 2015.


For more information about evidence-based programs for fall prevention, check out the Matter of Balance program at MaineHealth at www.mainehealth.org/mob and the Stepping On program at the Wisconsin Institute for Aging at https://wihealthyaging.org/stepping-on.

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