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: [email protected] Phone: 303-440-2159
Boulder Community HomeCareJody Marken, PTEmail: [email protected]: 303-441-0444