Healthy Aging

Loren Bonner

Is there more to the conversation about the risk of falls in older adults that pharmacists and other health care providers might be missing out on?

A new study in JAMA Internal Medicine highlights a missed opportunity to give older adults greater ability to live independently and safely at home. Researchers from the University of California, San Francisco, found that out of 12 million older adults over 65 years of age who live at home, 5 million do not have simple equipment—like grab bars or shower seats—that could help them safely bathe and use the toilet.

Most of these items cost less than $50 and are available at a pharmacy.

“The bathroom is the number one place for risk for falls,” said Ami Benson, CPhT, a durable medical equipment (DME) specialist at Bremo Pharmacy in Richmond, VA.

Falls are the biggest concern for older adults—it’s a leading cause of hospitalization and disability for this patient population.

Pharmacists learn about medications and falls, but helpful devices in the home as well as DME often gets lost in the conversation.

“It’s an area that has been masked for so many years,” said Lynne Eckmann, PharmD. “So many accidents happen in the bathroom, and we are not looking at this.”

Eckmann, who is director of a program in Lexington, KY, that helps older adults live independently at home or in assisted living facilities, sees the “cascade” of problems that can result from such falls—not only loss of independence for the patient, but massive costs to the health care system, too. A fall can lead to a patient requiring a higher level of care, like being admitted to a hospital for an acute injury and later to a rehabilitation facility.

“It’s always reactionary,” said Eckmann. “The fall happens and then they realize this basic equipment is needed. And so many don’t even know it’s out there.”

Barriers

Like so many issues in health care, there are barriers at every turn for something that seems so simple.

First of all, Medicare does not cover medical equipment in the bathroom. The agency views it as a commodity and not a necessity, according to Meredith Ayers, CPhT, the administrative coordinator at Bremo Pharmacy.

“We feel like insurance is an issue,” said Ayers. 

There are caveats where Medicare coverage is possible but working through them takes time and resources.

Emily Peron, PharmD, MS, associate professor of geriatrics at Virginia Commonwealth University School of Pharmacy, works with older adult patients on a fixed income.

“If your monthly income is $800, a grab bar is expensive,” she said. It’s the same decision some patients have to face when choosing whether to spend money on their medication or on food. In other words, the grab bar is low priority.

Beyond cost, the issues are myriad.

“What if you buy the wrong equipment? Who installs it? Does it fit in the bathroom? Health literacy even comes into play because someone has to follow directions,” said Leighton Mascari, PharmD, a pharmacist at Bremo Pharmacy.

“If you don’t have a care partner, it can put you at such a loss,” said Ayers.

The stigma of old age can also be a barrier. “Sometimes it’s not access, but also perception—the attitude that ‘I don’t need it,’” said Eckmann.

‘Think beyond our pharmacy hat’

As Peron points out, it takes time to understand patients and their unique barriers. “There is no one size fits all,” she said.

Peron will often refer her patients to Bremo Pharmacy, where they have resources and staff who can help older adults navigate some of this care.

Bremo Pharmacy has one section of the pharmacy dedicated to safety equipment for older adults and those with disabilities.

Mascari said there are touchpoints where this education can be integrated into a pharmacist’s interaction with patients—for instance, during an annual wellness visit or a falls risk assessment.

“We need to think beyond our pharmacy hat,” said Peron. “It’s not just about the medications.”

CDC’s new campaign aims to prevent injuries for older adults

CDC announced a new campaign called Still Going Strong in May 2020 to raise awareness about the leading causes of unintentional injuries and deaths in older adults, including falls, motor vehicle crashes, and traumatic brain injury. The campaign, which will have national reach through digital and social media and partner efforts, encourages older adults to continue participating in their favorite hobbies and activities, while informing them and their caregivers of steps they can take to prevent injuries.

The Still Going Strong campaign will initially launch in four states: Maine, Oklahoma, Oregon, and Wisconsin. All these states have a higher incidence of older adult falls, fall injuries, motor vehicle crashes, and deaths caused by injuries.