How can pharmacists help to prevent falls?

senior has fallen down

New research from Monash University links falls with medication initiation and dose changes

Researchers from Monash University’s Centre for Medicine Use and Safety (CMUS) have conducted a root cause analysis of fall-related hospitalisations (n=47) across 40 aged care residents over a 12-month period.

They found that 55.3% of fall-related hospitalisations were among residents with a history of falls.

Among all fall-related hospitalisations, at least one high falls risk medication was administered regularly prior to hospitalisation, results published in Aging Clinical and Experimental Research this month reveal.

For 73% of fall-related hospitalisations, residents were exposed to polypharmacy (use of nine or more medications) in the previous two weeks.

Potential root causes for falling included medication initiations and dose changes, the authors found.

“Falls risk medications include psychotropic medications, for example antidepressants, benzodiazepines, antipsychotics, and medications that can cause orthostatic hypotension,” explains co-author Professor Simon Bell.

Medications are therefore a potentially modifiable risk factor for falling, he says, adding that up to 50% of people in residential aged care facilities fall at least once a year.

Falls prevention is partly dependent on health practitioners being able to recognise resident susceptibility to medication-related falling due to factors such as renal impairment, orthostatic hypertension, or change in blood-brain barrier permeability, say the authors.

Professor Bell says the research shows possible new strategies involving pharmacists to minimise falls-related hospitalisations includes:

  • Pharmacists providing alerts to aged care provider nurses and staff when falls risk medications are initiated or the doses changed.
  • Pharmacists conducting targeted ‘falls risk medication reviews’ that consider the use of specific falls risk medications in the context of a resident’s background risk of falling due factors such as dementia or frailty status.
  • Medication charts including ‘falls risk status’.
  • Pharmacists providing training to support to aged care nurses and care workers related to the identification and monitoring of falls risk medications.
  • Flags related to use of falls risk medications being incorporated into electronic medication management systems.

Overall the research findings reinforce the value of residential medication management reviews (RMMRs) to “help ensure each resident’s medication regimen is consistent with their current goal of care,” says Professor Bell.

This is compatible with the Royal Commission into Aged Care Interim Report, which recommended changes to funding and eligibility criteria to increase the uptake, enhance the quality and monitor the followup of RMMR recommendations.

The research was conducted by CMUS with grant funding from Resthaven Inc and the National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing.

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