identifying fall risk: strategies to prevent falls
TRANSCRIPT
Identifying Fall Risk: Strategies to Prevent Falls
Teri Hecht, R.PhBoard Certified Geriatric PharmacistSeptember 18, 2020
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Learning Objectives
• Identify potential fall risk factors• Determine high risk medication that
may contribute to falls• Implement key fall interventions• When to refer to pharmacist for review• Use national fall prevention programs
to assist with patient/family education
What is the leading cause of fatal and non-fatal injury among adults 65 years of age and older?A. Motor vehicle accidentsB. SuffocationC. FallsD. Fires/burns
Huge impact on quality of life
Among people who fall, less than half talk to their healthcare provider about it.
Resources for Fall Prevention
• https://www.cdc.gov/steadi/materials.html
Additional resources available at www.cdc.gov/steadi/patient.html.
ncoa.org/healthy-aging/falls-prevention/falls-prevention-awareness-day/general-resources/infographics-handouts/
▪ 6 Steps to Prevent a Fall infographic and video▪ 6 Steps to Protect Your Loved One from a Fall▪ Winterize to Prevent Falls▪ Osteoporosis and Falls▪ Osteoarthritis and Falls▪ Myths about Falls▪ All available at no cost:
www.ncoa.org
National Council on Aging Resources and Handouts
Dizziness
/Vertigo
Cardiovascular disease
Neurological condition
Medical Conditions
Vision/hearing Impairment
Peripheral Neuropathy
Proprioception
Impaired Sensory
Muscle weakness
Gait & balance disturbance
Decreased body weight
Age related Changes
Intrinsic Risk Factors
Intrinsic Risk Factors
Demographic
Age Gender Race
Medications PersonalFactors
Environmental Hazards
High Risk Medication Ill fitting footwear Throw rugs
Polypharmacy Inappropriate walking aids
Poor Lighting
Medications Nocturnal Voiding Electrical Cords
Extrinsic Risk Factors
Medication and Fall Risk “FRID’s”
•Psychotropics
•Anti-diabetic
•Opioid analgesics
•Cardiovascular agents
•Antiepileptics
•Antidepressants
■ Anticholinergics: oxybutynin, amitriptyline, diphenhydramine.■ Antihistamines: hydroxyzine■ Medications impacting blood pressure: doxazosin■ Muscle relaxants: cyclobenzaprine, methocarbamol
30% lower risk for stroke
21% increased
risk for falls
Cardiovascular Medication Use: RISK VS BENEFIT
Mrs. Doubtfire is 81 year old female
Case Study
Mrs. Doubtfire is an outgoing 81-year-old Caucasian womanShe lives in an assisted living community. Her son reports that she was just seen in the hospital’s emergency room a week ago because she fell when she was getting out of the shower. Mrs. Doubtfire has a history of hypertension, hyperlipidemia, diabetes, CAD, and CHF.
Her Son indicates she has had “too manyfalls to count.” Mrs. Doubtfire agrees that she falls a lot, but she’spessimistic. “Old people fall, that’s just how it is,” she says.
MEDICATION LIST:Lantus 20 units subcutaneously at bedtimeLisinopril 20 mg dailyMetoprolol Succinate ER 200 mg dailySpironolactone 12.5 mg dailyFurosemide 20 mg dailyPotassium Chloride 20 mEq dailyDigoxin 125 mcg dailyFluoxetine 40 mg dailyClonazepam 1 mg qhs as needed for sleepAtorvastatin 10 mg at bedtimeAspirin 81 mg dailyVITALS: Supine – 129/53, 59; Sitting – 103/40, 60; Standing –101/51, 62.
SAFE Medication Review FrameworkA Team-based Approach Use this framework to conduct a medication review to help prevent older adult falls.
SScreen for medications that may increase fall risk.
AAssess the patient to best manage health conditions.
FFormulate the patient’s medication action plan.
EEducate the patient and caregiver about medication changes and fall prevention strategies.
2016
Formulate the patient’s medication action plan.
■ Stop medications when possible
MEDICATION LIST:Lantus 20 units subcutaneously at bedtimeLisinopril 20 mg dailyMetoprolol Succinate ER 200 mg dailySpironolactone 12.5 mg dailyFurosemide 20 mg dailyPotassium Chloride 20 mEq dailyDigoxin 125 mcg dailyFluoxetine 40 mg daily
Clonazepam 1 mg qhs as needed for sleepAtorvastatin 10 mg at bedtimeAspirin 81 mg dailyVITALS: Supine – 129/53, 59; Sitting – 103/40, 60; Standing –101/51, 62.
■ Switch to safer alternatives
Formulate the patient’s medication action plan.
MEDICATION LIST:Lantus 20 units subcutaneously at bedtimeLisinopril 20 mg dailyMetoprolol Succinate ER 200 mg dailySpironolactone 12.5 mg dailyFurosemide 20 mg dailyPotassium Chloride 20 mEq dailyDigoxin 125 mcg daily
Fluoxetine 40 mg dailyClonazepam 1 mg qhs as needed for sleepAtorvastatin 10 mg at bedtimeAspirin 81 mg daily
Formulate the patient’s medication action plan.
MEDICATION LIST:Lantus 20 units subcutaneously at bedtimeLisinopril 20 mg dailyMetoprolol Succinate ER 200 mg dailySpironolactone 12.5 mg dailyFurosemide 20 mg dailyPotassium Chloride 20 mEq dailyDigoxin 125 mcg dailyFluoxetine 40 mg dailyClonazepam 1 mg qhs as needed for sleepAtorvastatin 10 mg at bedtimeAspirin 81 mg daily
Educate the patient and/or
caregiver about medication changes and fall prevention strategies. Discuss the following:■ Reasons for medication changes■ Steps for implementing action plan ■ Other approaches to reduce fall risk ■ Importance of referrals to specialists such as PT/OT/vision check
1 Have the patient lie down for 5 minutes.2 Measure blood pressure and pulse rate.3 Have the patient stand.4 Repeat blood pressure and pulse rate measurementsafter standing 1 and 3 minutes.
MeasuringOrthostaticBlood Pressure
A drop in BP of ≥20 mm Hg, or in diastolic BP of ≥10 mm Hg, orexperiencing lightheadedness or dizziness is considered abnormal.
Who Has High Risk for Falls??
•Time frame of 1 month post hospital discharge
•Suffered a fall within past 12 months
•Diagnosed as a frail individual
•Acute illness
•Exacerbations of chronic illness
Identify and address fall risk factors
Refer as needed to specialists or community programs
Follow up with patient in 30 days
KEY STEPS FOR FALL PREVENTION
KEY FALL INTERVENTIONS
• Add Vitamin D supplementation• Modify medication• Manage hypotension• Prevent hypoglycemia • Address foot and vision problems• Enhance strength and balance• Educate patient and family• Optimize safety
Involve Your Consultant Pharmacist
• Provide a list of residents who have suffered a fall prior to each MRR
• Invite the consultant pharmacist to routine fall review meetings
• Request a medication review after a fall
• High risk resident with history of falls and complicated regimen
“Any new symptom in an older patient should be considered a drug side effect until proven otherwise”
Questions?
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(425) 308-0400
Sources
• www.cdc.gov/steadi• ncoa.org/healthy-aging/falls-prevention/falls-prevention-
awareness-day/general-resources/infographics-handouts/• https://www.medscape.com/viewarticle/841020• https://www.medscape.com/viewarticle/831517• https://www.youtube.com/watch?v=o54v_tuEvpw• JAMA Intern Med. 2015; 175 (3): 450-452