"Medication Interventions for Fall Prevention in the Older Adult." J

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Fall prevention in older adults Reviewsbreakfast and supper meals■■ Omeprazole: 20 mg every morningIntervention outcome. The patient and his family are nowconsidering his return to assisted living with one attendingprescriber, medication supervision, and monthly medicationreview by the pharmacist at a savings of $3,500 to $4,000 permonth in care costs versus the skilled nursing facility.Table 2 lists some psychoactive medications that increasethe risk of falls for patients 65 years of age or older. Pleasealso see the related University of North Carolina at ChapelHill news release (available at http://uncnews.unc.edu/news/health-and-medicine/some-drugs-increase-risk-of-fallingunc-researchers.html).Table 2 does not include antihistamines,all anticonvulsants and opioids, and centrally actingsympatholytic antihypertensives. The complete list can bedownloaded at http://uncnews.unc.edu/images/stories/news/health/2008/drugslist.pdf.SummaryThis article has reviewed the effects of medications onfalls and offers suggestions to minimize fall risk by assessingall medications both prescribed and possibly needed toreduce fall risk. The recommendations that can be made aresummarized in Table 3. References 1 through 54 and onlineAppendix 1 give further evidence for the need and effectivenessof multimodality interventions.References1. Kiel DP, O’Sullivan P, Teno JM, et al. Health care utilizationand functional status in the aged following a fall. Med Care.1991;29:221–8.2. Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderlybased on the number of chronic disabilities. Am J Med.1986;80:429–34.3. Prudham D, Evans JG. Factors associated with falls in the elderly:a community study. Age Ageing. 1981;10:141–6.4. Gryfe CL, Amies A, Ashley MJ. A longitudinal study of falls inan elderly population. I. Incidence and morbidity. Age Ageing.1977;6:201–10.5. Wild D, Nayak USL, Isaacs B. Characteristics of old people whofell at home. J Clin Exp Geront. 1980;2:271–7.6. Cooper JW. Preventing falls and fractures in nursing facility patients.Nurs Home Pract. 1994;2:28–30.7. Cooper JW. Drugs that cause falls in the nursing home. NursHomes. 1993;42:45–7.8. Tinetti M, Baker DI, McAvay G, et al. A multifactorial interventionto reduce the risk of falling among elderly living in the community.N Engl J Med. 1994;331:821–7.9. Sloane PD, Mathew LJ, Scarborough M, et al. Physical and pharmacologicrestraints of nursing home patients with dementia.JAMA. 1991;265:1278–82.10. Buck JA. Psychotropic drug practice in nursing homes. J AmGeriatr Soc. 1988;36:409–18.11. Ray WA, Griffin MR, Downey W. Benzodiazepines of long andshort elimination half-life and the risk of hip fracture. JAMA.1989;62:330–7.12. Jansen EC, Wachowiak-Andersen G, Munster-Swendsen J, etal. Postural stability after oral premedication with diazepam.Anesthesiology. 1985;65:557–9.13. Cooper JW. Falls and fractures in nursing home patientsreceiving psychotropic drugs. Int J Geriatr Psychiatry.1994;9:975–80.14. Greenblatt DJ, Harmatz JS, Shapiro L, et al. Sensitivity to triazolamin the elderly. N Engl J Med. 1991;324:1691–8.15. Cooper JW. Falls in nursing home patients receiving classicalantihistamines while stabilized on psychoactive medications. JPharmacoepidemiology. 1996;5:45–51.16. Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug useand the risk of hip fracture. N Engl J Med. 1987;316:363–9.17. Cooper JW, Cobb HH, Burfield AH. Buspirone conversion effecton falls, injuries, behavior and costs in a rural geriatric nursinghome population. Consult Pharm. 2001;16:358 –63.18. Cooper JW. Consultant pharmacist assessment and reduction offall risk in nursing facilities. Consult Pharm. 1997;12:1294–304.19. Cooper JW. Consultant pharmacist assessment of fall injuryincidence and costs within a nursing facility. Consult Pharm.1997;12:1305–9.20. Cooper JW. Reducing falls among patients in nursing homes.JAMA. 1997;278:1742.21. Centers for Medicare & Medicaid Services. Hospital-acquiredconditions (HAC) in acute inpatient prospective payment system(IPPS) hospitals. Accessed at www.cms.hhs.gov/Hospital-AcqCond/Downloads/HACFactsheet.pdf, February 15, 2009.22. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in olderpeople: a systematic review and meta-analysis. I. Psychotropicdrugs. J Am Geriatr Soc. 1999;47:30–9.23. Cooper JW. Adverse drug reaction-related hospitalizationsof nursing facility patients: a 4-year study. South Med J.1999;92:485–90.24. Sleeper R, Bond CA, Rojas-Fernandez C. Psychotropic drugs andfalls: new evidence pertaining to serotonin reuptake inhibitors.Pharmacotherapy. 2000;20:308–17.25. Weiner DK, Hanlon JT, Studenski SA. Effects of central nervoussystem polypharmacy on falls liability in community-dwellingelderly. Gerontol. 1998;44:217–21.26. Cooper JW. Drugs may have reduced effect of falls intervention.BMJ. 2001;322:675.27. Cooper JW, Freeman MH, Cook CL, Burfield AH. Psychotropicand psychoactive drug load assessment and falls in nursing facilityresidents. Consult Pharm. 2007:22:483–9.28. Cooper JW, Freeman MH, Cook CL, Burfield AH. Psychotropicand psychoactive drugs and hospitalization rates in nursing facilityresidents. Pharmacy Practice. 2007;5(3):140–4.29. Reisberg B, Ferris SH, deLeon MJ, et al. A global deteriorationscale for assessing dementia. Am J Psychiatry. 1982:139:1136–9.30. Fick DM, Cooper JW, Wade WE, et al. Updating the Beer’s criteriafor potentially inappropriate medication use in older adults.Arch Intern Med. 2003;163:2716–24.31. Perri M, Menon AM, Desspande AD, et al. Adverse outcomesassociated with inappropriate drug use in nursing homes. AnnPharmacother. 2005;39:405–11.32. Douzjian M, Wilson C, Schults M, et al. A program to use paincontrol medication to reduce psychotropic drug use in residentswith difficult behavior. Ann Long Term Care. 1998;6(5):174–8.33. Cooper JW, Burfield AH. Acetaminophen intervention in agitatedolder adults with cognitive impairment and multiple fallswith psychotropic agents. In preparation.Journal of the American Pharmacists Association www.japha.org M a y /Ju n 2009 • 49:3 • JAPhA • e81
Reviews Fall prevention in older adults34. Cooper JW, Burfield AH. Changes in hypnotic use with staffcaregiver education and medication order changes. In preparation.35. Shumway-Cook A, Silver IF, LeMier M, et al. Effectiveness of acommunity-based multifactorial intervention on falls and fallrisk factors in community-living older adults: a randomized,controlled trial. J Gerontol A Biol Sci Med Sci. 2007;62:1420–7.36. Ray WA, Taylor JA, Brown AK, et al. Prevention of fall-relatedinjuries in long-term care: a randomized controlled trial of staffeducation. Arch Intern Med. 2005;165:2293–8.37. Cumming RG, Sherrington C, Lord SR, et al. Cluster randomisedtrial of a targeted multifactorial intervention to prevent fallsamong older people in hospital. BMJ. 2008 ;336:758–60.38. Daal JO, van Lieshout JJ. Falls and medications in the elderly.Neth J Med. 2005;63(3):91–6.39. Reifkohl EZ, Bieber HL, Burlingame MB, Lowenthal DT. Medicationsand falls in the elderly: a review of the evidence and practicalconsiderations. P&T. 2003;28:724–33.40. American Geriatrics Society, British Geriatrics Society, AmericanAcademy of Orthopedic Surgeons Panel on falls prevention.Guideline for the prevention of falls in older persons. J AmGeriatr Soc. 2001;49:664–72.41. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventionsfor preventing falls in elderly people. Cochrane Database SystRev. 2009;Apr 15(2):CD000340.42. Tinetti ME. Preventing falls in elderly persons. N Engl J Med.2003;348:42–9.43. McClure R, Turner C, Peel N, et al. Population-based interventionsfor the prevention of fall-related injuries in older people.Cochrane Database Syst Rev. 2005;Jan 25(1):CD004441.44. Pandya N, Bookhart B, Mody SH, et al. Study of anemia in longtermcare (SALT): prevalence of anemia and its relationship withthe risk of falls in nursing home residents. Curr Med Res Opin.2008;24:2139–49.45. Duh MS, Mody SH, Lefebvre P, et al. Anaemia and the risk of injuriousfalls in a community-dwelling elderly population. DrugsAging. 2008;25:325–34.46. O’Donnell S, Moher D, Thomas K, et al. Systematic review ofthe benefits and harms of calcitriol and alfacalcidol for fracturesand falls. J Bone Miner Metab. 2008;26:531–42.47. Prince RL, Austin N, Devine A, et al. Effects of ergocalciferoladded to calcium on the risk of falls in elderly high-risk women.Arch Intern Med. 2008;168:103–8.48. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effectof vitamin D on falls: a meta-analysis. JAMA. 2004;291:1999–2006.49. American Hospital Formulary Service Drug Information 08. Sectionson oral calcium salts and vitamin D. Bethesda, MD: AmericanSociety of Health-System Pharmacists; 2008:2722, 3658.50. Wade WE, Cooper JW. Bowel obstruction associated with fiberadministration within an entire nursing facility population. JGeriatr Drug Ther. 1997;12(1):94.51. Cooper JW, Burfield AH. Medication therapy management(MTM) strategies for geriatric patient interventions: MedicarePart D implementation. Ann Long Term Care. 2007;15(7):33–8.52. Centers for Disease Control and Prevention, National Centerfor Injury Prevention and Control. Web-based Injury StatisticsQuery and Reporting System (WISQARS). Accessed at www.cdc.gov/ncipc/wisqars, January 15, 2007.53. Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall riskin community-living older adults: a 1-year prospective study.Arch Phys Med Rehabil. 2001;82(8):1050–6.54. Hornbrook MC, Stevens VJ, Wingfield DJ, et al. Preventing fallsamong community-dwelling older persons: results from a randomizedtrial. Gerontologist. 1994:34(1):16–23.55. Cooper JW. Reducing psychotropic drugs reduces falls in elderlypeople. BMJ. 2001;323:402.56. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.e82 • JAPhA • 49:3 • M a y /Ju n 2009www.japha.orgJournal of the American Pharmacists Association
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