Fall prevention: Medications and home safety

1. Fall prevention: Medications and home safety Falls Prevention: Medications and Home Safety Brenda Mehos, PharmD • Jody Marken, PT

2. “Unintentionally and unexpectedly coming to rest on the ground or another lower level.” Definition of a Fall

3. 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

4. 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

5. 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

6. 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

7. 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

8. TreatingAdverse Reactions: Cascade #1 • Antipsychotic Med • Antiparkinson Med • Anticholinergic Med Shaking Dizziness Sedation

9. Treating adverse reactions: Prescribing cascade #2 • NSAID • Antihypertensive • Gout treatment Edema/fluid retention Increased uric acid Confusion

10. 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

11. Fall Risk Due to Medications Medications That Affect the Central Nervous System: • Sleeping medications, Including over-the-counter benadryl (diphenhydramine) • Pain medications • Antidepressants • Anticonvulsants

12. Medications That Cause Low Blood Pressure • Antiarrhythmics • Antihypertensives • Nitrates • Vasodilators • Diuretics

13. And the List Continues • Antihistamines • Hypoglycemic drugs • Nonsteroidal anti-Inflammatory drugs or NSAIDS (Indocin, Ibuprofen, Naproxen) • Diuretics or laxatives used later in the day

14. 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

15. Strengthen Your Bones • Bone strengthening medications such as bisphosphonates and calcium • Vitamin D – Get at least 800 IU of Vitamin D3 daily

16. 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

17. Questions ?

18. Physical Mobility • Strength • Balance • Flexibility

19. 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

20. Excessive fear of falling leads to: • Restriction in physical activity • De-conditioning • Poor quality of life • Social isolation • Depression or psychological distress

21. Others may underestimate their risk of falling

22. 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

23. What is your risk for falling?

24. Let’s look at the home - Take a virtual tour …

25. Entrance Outdoor walkways: • Traction • Surface • Exposure to the extremes Accessibility: • Ramps / platforms • Railings • Doorway Visibility: • Lighting / contrast

26. Living Room • Height of chair/couch • Clear a pathway – remove cords and clutter • Flooring - transition flooring and thresholds • Rugs

27. Kitchen • Easy access to food and water • Clear and accessible work space • No step ladders or stools

28. 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

29. Office • Pathways cleared of cords, papers, clutter • Stable chair

30. Laundry • Location • Transport of laundry • Need for assistance • Access to and size of laundry products

31. Stairs • Height of steps • Surface • Lighting • Alternatives to stairs

32. Stair Railings • Sturdy • Both sides • Top to bottom • Easy to hold

33. Bathroom • Access to tub versus shower • Floor surface • Toilet height • Access to mobility devices

34. Bathroom Equipment • Textured grab bars • Shower seat • Tub bench • Hand held shower hose • Toilet risers or rails • Bedside commode

35. General Safety Proper footwear • Non-slip and supportive – function versus fashion Access to the following: • Phone • Windows • Blinds • Thermostat Plan for emergencies • Need for a Personal Emergency Response System (LIFELINE)

36. How can we help you? Boulder Community Hospital Brenda Mehos, PharmD Email: bmehos@bch.org Phone:303-440-2159 Boulder Community HomeCare Jody Marken, PT Email: jmarken@bch.org Phone: 303-441-0444