Fall prevention:Medications and home safety

Brenda Mehos, PharmD

Jody Marken, PT

Falls Prevention:Medications and Home Safety

“Unintentionally and unexpectedly coming to rest on the ground or another lower level.”

Definition of a Fall

Fall Facts

• 1 in 3 adults over 65 fall each year

– Leading cause of hospitalization

– One of the leading causes of injury-related deaths

– Most common cause of non-fatal injuries

• 60% of falls occur in the home

Going Forward …Falls• Preventable and controllable• NOT an inevitable result of aging• Reduce your risk of falls

– Medication management– Improve physical mobility– Control fear of falling– Annual vision screening– Change your environment

Medication Management

• Patients on 4 or more drugs are at a greater risk for falls

• Several drug classes associated with falls– Sleep medications– Antidepressants– Heart medications– Pain medications

Polypharmacy

• Use of multiple, concurrent medications • Excessive or unnecessary medications

– Prescription medications– Herbals and supplements– Over-the-counter products

• Affects about 40% of older adults living in their own homes

Cause of Polypharmacy

• Multiple disease states, physicians, and pharmacies

• Treating side effects with more medications• Continuing “discontinued” medications

– After hospitalization– Vision problems

• Self medication and sharing medications with friends

Treating Adverse Reactions: Cascade #1

• Antipsychotic Med• Antiparkinson Med

• Anticholinergic Med

ShakingDizzinessSedation

Treating adverse reactions: Prescribing cascade #2

• NSAID• Antihypertensive• Gout treatment

Edema/fluid retentionIncreased uric acidConfusion

Appropriate Treatment 1 Year Post MI

• A Statin such as Atorvastatin• An ACEI inhibitor such as Lisinopril• A Beta-Blocker such as Carvedilol• Aspirin• Antidepressant

Fall Risk Due to MedicationsMedications That Affect the Central Nervous

System:• Sleeping medications, Including

over-the-counter benadryl (diphenhydramine)

• Pain medications• Antidepressants• Anticonvulsants

Medications That Cause Low Blood Pressure

• Antiarrhythmics• Antihypertensives• Nitrates• Vasodilators• Diuretics

And the List Continues

• Antihistamines• Hypoglycemic drugs• Nonsteroidal anti-Inflammatory drugs or

NSAIDS (Indocin, Ibuprofen, Naproxen)• Diuretics or laxatives used later in the day

How to Prevent Fall Risk Due to Medications

• Work With Your Healthcare Providers:– Ask for a medication review yearly– Minimize number of medications, if possible– Use one pharmacy– Carry a list of your medications in purse or

wallet

Strengthen Your Bones

• Bone strengthening medications such as bisphosphonates and calcium

• Vitamin D – Get at least 800 IU of Vitamin D3 daily

Know When To Ask For Help

• Medication causing dizziness• Still sleepy in morning after taking sleeping

medication• Ask for clarification and know your meds

– Trade name vs generic name– Indications– Duplications– Side effects– Changes after hospitalization

Questions ?

Physical Mobility

• Strength

• Balance

• Flexibility

Balance• Vestibular system – responds to

signals from inner ear (the position of your head and movement)

• Proprioceptive system – responds to signals from muscles and joints to determine where the body is positioned in space

• Visual system – allows us to process visual detail

Excessive fear of falling leads to:

• Restriction in physical activity• De-conditioning• Poor quality of life• Social isolation• Depression or

psychological distress

Others may underestimate their risk of falling

Other risk factors • Vision problems• Sensory deficits• Judgment concerns (confusion, disorientation,

alcohol abuse)• Urinary or bowel frequency and urgency• Multiple diagnoses/problems• Inadequate support system

What is your risk for falling?

Let’s look at the home - Take a virtual tour …

EntranceOutdoor walkways:• Traction• Surface• Exposure to the extremesAccessibility:• Ramps / platforms• Railings• DoorwayVisibility:• Lighting / contrast

Living Room• Height of chair/couch• Clear a pathway – remove cords and clutter• Flooring - transition flooring and thresholds• Rugs

Kitchen• Easy access to food and water• Clear and accessible work space• No step ladders or stools

Bedroom• Proper height of bed• Bed linens • Clear pathway to the bathroom• Night light or flashlight – Never get up in the

dark• Access to the phone

Office• Pathways cleared of cords, papers, clutter

• Stable chair

Laundry

• Location

• Transport of laundry

• Need for assistance• Access to and size of laundry

products

Stairs• Height of steps• Surface• Lighting• Alternatives to

stairs

Stair Railings• Sturdy• Both sides • Top to bottom• Easy to hold

Bathroom• Access to tub versus

shower• Floor surface• Toilet height• Access to mobility

devices

Bathroom Equipment• Textured grab bars • Shower seat• Tub bench• Hand held shower hose• Toilet risers or rails• Bedside commode

General SafetyProper footwear

• Non-slip and supportive – function versus fashionAccess to the following:

• Phone• Windows• Blinds• Thermostat

Plan for emergencies• Need for a Personal Emergency Response System

(LIFELINE)

How can we help you?Boulder Community Hospital

Brenda Mehos, PharmDEmail: bmehos@bch.org Phone: 303-440-2159

Boulder Community HomeCareJody Marken, PTEmail: jmarken@bch.orgPhone: 303-441-0444