Program raises awareness of fall risk among seniors

According to the Home Safety Council (HSC), falls at home cause an average of more than 4,700 deaths and 1.1 million medical visits each year among adults aged 65 and older. In 2002, approximately 38% of all unintentional injury deaths among older adults were caused by falls, and many were associated with medication use.

In response to escalating concerns regarding falls and fall-related injuries among older adults, the HSC, the National Council on the Aging (NCOA), and the Archstone Foundation recently launched an initiative entitled Falls Free: Promoting a National Falls Prevention Action Plan.

The National Action Plan is a monograph that addresses the challenges and barriers related to a national falls-prevention initiative. It outlines key strategies and action steps to help reduce fall dangers for older adults. It is available at http://www.healthyagingprograms.org/.

Last year, as the HSC developed an educational program for senior centers, it decided that rather than focus exclusively on home modification to prevent falls, they should expand the purview of this program, Appy explained. The council decided to include additional messages, such as the importance of medication reviews, during which a physician or pharmacist would review the older person's medication regimen once a year, so that it could be adjusted as necessary, she said. "One thing I loved about working with the Falls Free Coalition is that various experts were able to contribute their knowledge and expertise on this issue," said Appy. "Pharmacists in particular have the appropriate background to help us improve the delivery of our message and the quality of our research, and understand how medications can increase fall risk and how they can be used appropriately."

Appy went on to say that pharmacists are a trusted source of information and very often are face-to-face with patients. "I know the NCOA and the steering committee deliberately sought out pharmacists for this very reason," she said.

"Pharmacists should be proactively involved in helping to prevent falls," said Carla Saxton, R.Ph., CGP, Professional Affairs Manager for the American Society of Consultant Pharmacists. "No matter what setting pharmacists practice in, they have the potential to prevent falls and fall-related consequences."

Many medications can contribute to falls, Saxton explained, citing sleep aids and hypnotics, pain medications containing opioids, and agents with anticholinergic properties as examples of commonly prescribed drugs that can increase fall risk. She also mentioned the misconception that over-the-counter medications such as diphenhydramine (Benadryl, Pfizer) are safe and have no adverse effects. Benadryl, she said, is an excellent example of a drug with anticholinergic properties that can increase the risk of falling in older adults.

"If people fall, they often do not link medication use and fall risk," Saxton went on. "Pharmacists should consider medications first when falls occur, and ask themselves, 'Could this have been a medication-related problem?' before considering a new diagnosis that must be treated with yet another medication."

Pharmacists should talk to patients and caregivers to find out if the patient has fallen previously and if they are on a medication that may have contributed to that, Saxton continued. "If this is the case, pharmacists can recommend consulting the physician about changing the dose or the medication."

Saxon also suggested that pharmacists might let whoever is picking up the prescription know that their drug increases fall risk. "They may want to recommend, for example, that a path be cleared between the bedroom and the bathroom for those on a diuretic who get up in the middle of the night."

"I would love for pharmacists to consider themselves partners in this," Appy said, "and have them seek out others in the community, such as local fire departments or emergency medical technicians, who might be 'first responders' to a report of a fall.