As mentioned in the previous article, when caring for homebound patients, we reviewed the concerns regarding patient falls and impact on patient independence, and the incidence and cost. The cost of falls was between $19 Billion – $179 Billion for fatal and nonfatal falls in 2000 (last year for which data available). We reviewed preventive action such as exercise in the previous article, and will examine medication review and reconciliation further in this article. Later articles will include the role eye sight and cognition, and complete environmental assessment to identify, educate, and remove potential fall hazards.
Medications are a crucial part of managing patient care, however there is the need to monitor them closely and check for side effects, especially when caring for elderly patients who tend to react differently due to normal changes occurring with the aging process such as a prolonged half-life. A number of actions can minimize the risk of falls in patients with multiple medications and can be summarized as follows:
Comprehensive History – It is always extremely important to get an accurate and comprehensive listing of all medications (prescription and over the counter, especially herbals and alternative substances being taken) a patient is taking when a history is being taken.
Multidisciplinary Team – in order to optimally manage a patient with a large number of medications, a multidisciplinary team approach is crucial and must include a pharmacist
Confounding factors – a thorough assessment and adequate management of chronic diseases and conditions are necessary to ensure they are not the primary cause of the patient’s increased fall risk
The table below is an excellent summary of the common medications which can increase the risk of falls and should be examined thoroughly when completing the medication reconciliation process.
| Antidepressants† ‡ | Nonsteroidal anti-inflammatory drugs | Digoxin† |
| Antipsychotics† | Corticosteroids | Nitrates |
| Benzodiazepines† | Muscle relaxants | Hypoglycemics |
| Antihypertensives | Narcotic analgesics | Antiparkinson drugs |
| Antihistamines§ | Antiarrhythmics (type IA†) | Histamine H2-receptor blockers |
| Anticonvulsants† |
Adapted from Riefkohl, Bieber, Burlingame and Lowenthal (2003) originally published in P&T 28(11):726
* Not all drugs and drug classes listed have been associated with falls in published research. Therefore, this list should be used in the context of a comprehensive clinical assessment for each individual patient.
† Published research suggests an association between the use of this drug or drug class and an increased risk of falling.
‡ Includes selective serotonin reuptake inhibitors (SSRIs).
§ Especially sedating antihistamines, such as diphenhydramine HCl
(e.g., Benadryl®, Pfizer) and hydroxyzine (e.g.,Atarax®, Pfizer).
Sources
Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview – http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005.
Riefkohl, Bieber, Burlingame and Lowenthal (2003) P&T 28(11):726
