August 24, 2021
One quarter of Americans aged 65 and older fall each year, according to the National Council on Aging. And falls are the leading cause of fatal injury and nonfatal trauma-related hospital admissions among older adults.
Independent pharmacists are in an ideal position to help elderly patients prevent falls. Your expertise in drug therapy combined with your close relationship to your patients helps you to identify who is at risk, adjust their medication regimens, and provide counseling.
For your older patients, falls are a serious threat. According to the CDC, one in five falls leads to a serious injury like broken bones or a head injury.
When a patient falls once, it doubles their chances of falling again. Because they are afraid of falling, some patients will become less active, which makes them weaker and actually increases their fall risk.
Here are some ways to help minimize your patients’ risk of falling.
Many patients who have fallen neglect to bring it up with healthcare professionals. To get them the help they need, ask your older patients a few questions to identify risk factors and implement fall prevention measures.
Here are three questions recommended by the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative:
These questions are an excellent starting point for assessing risk and providing any necessary intervention or education.
Polypharmacy, or when patients use multiple medications, is a major contributor to falls, according to a 2016 study published in Frontiers in Public Health. Around a quarter of older adults take five or more prescription medications, increasing their fall risk.
Certain medications are particularly associated with an increase in falls, including:
Drugs with side effects that affect the central nervous system also increase the risk of falls. Look out for medications with side effects like:
Pharmacists can help address the risks of polypharmacy by providing medication therapy management (MTM) services.
Find out every medication the patient is taking, both prescription and over-the-counter medications and supplements. Analyze them for potential contraindications or duplications and look for ways to cut down on the number of drugs they are taking to reduce side effects.
Paying attention to adherence can also help. Sometimes, patients forget they have taken a medication and take it again, doubling the dosages and leading to potential adverse side effects.
Implement a medication adherence program like providing adherence packaging that sorts medications by the day and time they need to be taken. Then, patients can check the package to check if they’ve taken their evening dose or not.
Patients who aren’t confident on their feet are more likely to fall, and you can screen for that by evaluating their gait, strength, and balance.
If a patient has poor mobility, you can reduce their fall risk by referring them to a physical therapy program or recommending they start participating in evidence-based fall prevention programs like Tai Chi.
There are three common tests you can use to assess patients for mobility issues.
For the TUG test, you have a patient sit in a chair and identify a line on the floor 10 feet away. When you say “Go,” the patient should get up from their chair, walk to the line, walk back to the chair, and sit back down. Patients can use their regular walking aids for this test.
Patients who take longer than 12 seconds to complete this task are at a greater risk for falling. Other red flags include poor stability, uneven gait, short strides, and swaying.
This assessment tests leg strength and endurance. To conduct this test, patients sit in a chair with their arms crossed against their chest. With their feet flat on the floor and without using their arms, they should rise to a standing position and sit back down.
Time them for 30 seconds and record the number of times they stand in that period. You can compare their scores to an average for their age group to determine if they are at risk.
This test uses four different standing positions, each of which are progressively harder to maintain, to assess patients’ static balance.
Have the patient hold each position for 10 seconds without moving their feet. If they complete the first stage, go on to the second stage, and so on. If they fail to complete a stage, stop the test.
A patient who cannot complete the third stage of the test has a higher fall risk.
In addition to medical conditions and medication usage, certain environmental factors can increase fall risk. Ask your patients about what risk factors they may have hidden in their homes. Common environmental causes of falls include:
Your patients may not be aware of how these things can impact their fall risk, so educating them to be more aware can help mitigate that risk.
You can also help them make a plan to remedy some of these risk factors, like helping them find the right shoes to help their balance or connecting them with someone who can install safety measures like grab bars in their home.
If you identify any of your patients as a fall risk, be sure to follow up with them in 30 to 90 days to find out if they feel more confident on their feet or if they’ve run into any barriers while implementing medication, environmental, or lifestyle changes.
Educate yourself further on fall risks by using the provider resources available through STEADI.
The CDC and the American Pharmacists Association have also collaborated to create a free, accredited continuing education course on the pharmacist’s role in fall prevention.
PBA Health is dedicated to helping independent pharmacies reach their full potential on the buy side of their business. The company is a member-owned organization that serves independent pharmacies with group purchasing services, expert contract negotiations, proprietary purchasing tools, distribution services, and more.
An HDA member, PBA Health operates its own NABP-accredited (formerly VAWD) warehouse with more than 6,000 SKUs, including brands, generics, narcotics CII-CV, cold-storage products, and over-the-counter (OTC) products.
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