Falls and Medications

1. Falls and Medications Jane R. Mort, Pharm.D. - Professor of Clinical Pharmacy - South Dakota State University - South Dakota Foundation for Medical Care -

2. Falls and Medications Objectives: • Describe consequences of and risk factors for falls. • Identify medications that increase the risk of falls. • Describe how medications increase the risk of falls. • Utilize a systematic approach to evaluate a resident’s fall.

3. Falls Frequency • 1/3 elderly in community fall • 50% of nursing home residents fall

4. Consequences Serious injuries – 5-10% Hip fractures Some lack full recovery Death Repeated falls Disability Decreased quality of life Nursing home placement Cost Death Falls

5. Factors Leading to an Increase Risk of Falls Host factors • Visual impairments • Postural hypotension • Syncope • Lower Extremity Dysfunction • Hypothyroidism • Nocturia

6. Factors Leading to an Increase Risk of Falls Host factors • Osteoporosis • Dizziness • Drop Attacks • Confusion • Gait Problems

7. Factors Leading to an Increase Risk of Falls Environment • Poor Lighting • Objects on the Floor • Unstable Furniture • Stairs without Railings • Low Beds or Toilets

8. Nursing Home Gait, Balance, Strength – 26% Dizziness – 25% Environment – 16% Community Environment – 41% Gait, Balance, Strength – 13% Drop Attacks – 13% Most Common Causes of Falls

9. How Medications May Precipitate a Fall • Postural Hypotension • Muscle Coordination Problems • Sedation • Confusion • Dizziness

10. Antidepressants • Odds Ratio – 1.7 • Tricyclic Antidepressants (TCAs) vs Selective Serotonin Reuptake Inhibitors (SSRIs) • 2.0 vs 1.8 • Reasons for the findings

11. Benzodiazepines • Odds Ratio – 1.5 • Mechanism • Drowsiness • Dizziness • Confusion • Impaired Coordination • Long versus Short Half-life Agents

12. Antipsychotic Agents • Odds ratio – 1.5 • Mechanism • CNS Depressant Effects • Movement Disorders

13. Antihypertensive Agents • Studies have reported conflicting results • Mechanism • Dizziness • Postural hypotension • Syncope • Fatigue • Decreased Cerebral Blood Flow

14. Diuretics Odds Ratio – 1.8 Mechanism Orthostatic Hypotension Volume Depletion Electrolyte Abnormalities Calcium Channel Blockers Odds Ratio – 1.8-2.0 Mechanism: Hypotension Fatigue Muscle Weakness Dizziness Arrhythmia Antihypertensive Agents

15. Antiarrhythmics OR – 1.6 Mechanism Due to medications or underlying arrhythmia? Digoxin OR – 1.2 – 2.2 Mechanism Underlying disease Weakness Visual disturbances Arrhythmias Cardiovascular Agents

16. Narcotics Odds Ratio Mechanism CNS Depression Orthostatic Hypotension Dizziness NSAIDs Odds Ratio – Insignificant Possible Mechanisms Dizziness Confusion Mood changes GI toxicity Pain Medications

17. Polypharmacy • Number of Medications Associated with an Increased Risk • 1 med – 1.4 • 2 meds – 2.2 • 3 meds – 2.4 • Mechanism • Additive Effect • Compliance Problems • Indicates More Conditions

18. Assessing the Role of Medications in Falls RAP • Multiple falls? • Internal Risk Factors • Cardiovascular • Neuromuscular/Functional • Orthopedic • Perceptual • Psychiatric or Cognitive

19. Assessing the Role of Medications in Falls RAP • External Factors • MEDICATIONS • Prior to or after the fall? • If prior, how close was it administered to the fall? • Appliances and devices • Environmental/Situational Hazards • Vital signs • Things to do for those at risk for future falls

20. Medications in susceptible residents may increase the risk of falls. It is important to recognize the risk associated with the use of these medications and adjust therapy as necessary to prevent a fall.