PHARMACISTS PLAY A KEY ROLE IN FALLS PREVENTION Falls Prevention Awareness Day September 23, 2011 The most

effective falls prevention strategies use multiple efforts, including exercise programs, vision checks, home modifications and medication review and reconciliation. Polypharmacy and the use of potentially inappropriate medications (PIMS) in older adults are common risks for falls. Currently, more than one-quarter of adults over the age of 65 take five or more medications regularly per month and this number is rising steadily. Often these medications are prescribed by multiple providers who may be unaware of concurrent medications. In such cases, pharmacists play a key role in protecting patients from potentially dangerous drug interactions.

Medication Use by Older Adults in the USA

Cross sectional study, 3500 community dwelling individuals, aged 57-85, 2005-2006

81% 42% 49% 29% 46% 52% 4%

Used at least 1 prescription medication Used at least 1 OTC medication Used at least 1 CAM (complementary/alternative medicine) Used at least 5 prescription medications Used prescription medications with OTCs Used Prescription medications with CAM Will experience MAJOR drug/drug interaction
*Source JAMA 2008 December 24; 300(24): 2867-2878

CAM natural product use by older adults in the USA

National Health Interview Survey (NHIS) 2002

# of products out of the top 15 most used 6 5 4 2

Can contribute to fall risk by causing: Drowsiness, sedation Dizziness, vertigo Increased bleeding Low blood pressure

*Source Advanced Data, Vital Statistics, num 343 May 27, 2004 & Natural Medicines Comprehensive Database

Complementary and alternative medicine (CAM) use is more prevalent in New York City than the national average1 however most physicians do not adequately document CAM use among their patients. A study conducted at Mt Sinai School of Medicine1 found that doctors documented 35% CAM use among a given sample group, while the actual CAM use in the sample group was 64%. In that same sample group, nearly half reported taking CAM with anticoagulant properties which could cause or worsen bleeding if a fall injury occurs. Several of the most widely used natural products in the U.S. can cause side effects that increase fall risk or risk of serious outcome if a fall occurs.

Pharmacists are the most accessible and most visited health care professionals for many people. Older adults are increasingly speaking with their pharmacists about their overall health and medication concerns. This presents a golden opportunity for pharmacists to play a role in medication management and help reduce the risk of falling or for adverse events if a fall occur
1

Cohen, R., Ek, K., & Pan, C. (2002). Complementary and alternative medicine (CAM) use by older adults: a comparison of self-report and physician chart documentation. The Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences, 57(4), M223-M227.

What you can do for older adults on Falls Prevention Awareness Day Brown Bag Medication Review
Encourage patients to bring all prescriptions, OTCs, vitamins, supplements and herbals Review new or ceased medications (including supplements, herbals and OTCs), medication adherence and understanding, side effects Provide patient with updated medication listing Remind patients to bring log of ALL medications (including herbals, supplements and OTCs) to ALL health care provider appointments Encourage patients to use a single pharmacist to help manage multiple medications Call or send a letter to prescribing physician alerting them to potential issues and concerns

Discuss falls in older adults with your students and colleagues on Falls Prevention Awareness Day
Panel on Prevention of Falls in Older Persons. Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. Journal of American Geriatrics Society, 2010. Available at: http://www.americangeriatrics.org/health_care_professionals/clinical_practi ce/clinical_guidelines_recommendations/2010/ Ferreri S, Roth M, Casteel et al. Methodology of an Ongoing, Randomized Controlled Trial to Prevent Falls Through Enhanced Pharmaceutical Care. The American Journal of Geriatric Pharmacotherapy. 2008 Jun;6(2):61-81. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/18675765 St Johns Medical Center, Tulsa OK. Pharmacists can assist in fall prevention programs. Healthcare Benchmarks and Quality Improvement. 2010 Jan;17(1):7-9. Abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/20121008 Beasley B, Patatanian E. Development and Implementation of a Pharmacy Fall Prevention Program. Hospital Pharmacy. 2009;44(12)1095-1102. Article available at: https://www.factsandcomparisons.com/assets/hpdatenamed/20091201_Dec 2009_peer2.pdf Manolakis P, Skelton J. Pharmacists Contributions to Primary Care in the United Stated: Collaborating to Address Unmet Patient Care Needs: The Emerging Role of Pharmacists to Address the Shortage of Primary Care Providers. American Journal of Pharmaceutical Education. 2010;74(10) Article S7. Issue brief available at: http://www.hrsa.gov/publichealth/clinical/patientsafety/aacpbrief.pdf NYCDOHMH City Health Information: Preventing Falls in Older Adults in the Community. Available at: http://www.nyc.gov/html/doh/downloads/pdf/chi/chi29-4.pdf

The New York City Department of Health and Mental Hygiene, the New York City Department for the Aging and several key health and social service organizations have joined together to reduce the burden of falls among older adults in New York City. For more information about this group or how to get involved, please contact us at Fallsprevention@health.nyc.gov