Falls risk and medication

Selina Khanom : Dementia Team Pharmacist

 Aim
• To understand
how medication
can be a risk factor
for falls
 Objectives
1. Learn about the NSF for older people – what
it is and why it is relevant
2. Understand both why and how medicines
can increase risk of falls
3. Appreciate the importance of preventing
osteoporosis in older people
4. Learn tips on how to use medicines safely
 What are NSF’s?
• National Service Frameworks (NSFs) are
policies set by the NHS to define standards of
care for major medical issues such as cancer,
coronary heart disease, mental health and
diabetes. NSFs are also defined for some key
patient groups including children and older
people.
• We will be looking specifically at the NSF for
Older people
 Role of NSF
The two main roles of NSFs are:
1. Set clear quality requirements for care based
on the best available evidence of what
treatments and services work most
effectively for patients.
2. Offer strategies and support to help
organisations achieve these.
 How are NSF’s developed?
• Health professionals
• Patients
• Carers
• Health service
managers
• Voluntary agencies
• Other experts
 Why is the NSF for Older People
relevant?
• The aim of standard 6 of the NSF for Older

reduce the
People is to

number of falls that result in

serious injury and ensure
effective
treatment and rehabilitation
for those who have fallen.
Every year over 400,000 older people in England
attend A & E departments following a fall.
Preventing falls in frail older people will save lives and decrease disability.
 Preventing falls

Intrinsic Risk Environmental

factors Hazards
 Intrinsic risk factors
• Balance, gait or mobility problems including
those due to degenerative joint disease and
motor disorders such as stroke and parkinsons
disease
• Visual impairment
• Impaired cognition or depression
• Postural hypotension
• Taking 4 or more medicines, in particular
centrally sedating or blood pressure lowering
 Why is medication a risk factor?
• Polypharmacy = When a patient is prescribed
four or more drugs
• It is a risk factor for falls and potential harm in
older people
• Sometimes it is medication that is necessary,
but quite often it occurs over time when a
medication is simply not discontinued when
no longer needed
 Why is medication a risk factor?
Taking four or more medications significantly increases
the risk for falling because
1. There are a greater number of side effects
associated with multiple medication use and the
side effects are often more intense
2. Interactions between medications can also cause
side effects
3. Medications react differently in the body as a
person ages which can increase the risk for falling
 How medicines can cause falls
1. Sedation
2. Impaired postural stability (inability to maintain posture)
3. Hypotension (low blood pressure)
4. Drug induced parkinsonism (Parkinson like symptoms)
5. Visual impairment (blurred vision, dry eyes)
6. Hypoglycaemia (low blood sugar)
7. Vestibular damage (tinnitus, deafness)
8. Hypothermia (low body temperature)
9. Confusion
10. Dehydration
 How medicines can cause falls
Impaired postural Postural
Sedation/Drowsiness
stability hypotension
• Antidepressants • Hypnotics • Diuretics
• Antipsychotics • Sleep aids • Antipsychotics
• Parkinsons disease • Benzodiazpines
medication
 How medicines can cause falls

Drug induced Visual Impairment

Hypoglycaemia
Parkinsonism Blurred vision/Dry eyes
• Antipsychotics • Antihistamines • Beta blockers
• Drugs for urinary • Haloperidol
incontinence • Antidiabetic
medication
• Insulin
• Quinine
 How medicines can cause falls

Vestibular damage
Confusion Hypothermia
Tinnitus, deafness
• Water tablets • Antispychotics • Beta blockers
• Aspirin • Sedatives • Clonidine
• quinine, • Heart tablets • Antipschotics
• Certain • Sedative
antibiotics hypnotics also
decrease body's
ability to respond
to low ambient
temperature
 How medicines can cause falls
Dehydration

• Can increase
the risk of falls
and this might
occur in older
people taking
diuretics (water
tablets) and
laxatives
 Medication reviews

• In patients taking medicines

known to contribute to falls,
medication review can play an
important role in falls
prevention.
• Where a patient has fallen,
medication review and
subsequent prescribing
changes have been shown to
reduce further falls.
 What is a medication review
• ......“Structured review of the efficacy and
continuing appropriateness of a patients
medication”..

• A medication review may result in either

modification or withdrawal from a drug. If
neither are possible, close monitoring may be
appropriate.
 Osteoporosis Prevention
• Older people with osteoporosis will be at
increased risk of fractures if they fall.
• This patient group should be advised to
– Ensure adequate nutrition – especially with
calcium and vitamin D
– Perform regular weight bearing exercise
– Stop smoking
– Avoid alcohol
 Osteoporosis Prevention
• Bisphosphonates are commonly used for the
treatment and prevention of osteoporosis
• Taken ONCE weekly
• Some common examples include
Generic name Brand name
alendronate Fosamax
ibandronate Boniva
risedronate Actonel
 Osteoporosis Prevention
• Patients prescribed a bisphosphonate may
also be prescribed
– calcium tablets
– Vitamin D tablets

• Calcium should be taken at least half an hour

after bisphosphonate
 Tips for safe medication use
• Keep a list of all medications including
prescriptions, over the counter medications,
vitamins, and herbals.
• Keep all your medicines in the same place
• Ask questions about your medicines.
• Use only one chemist when possible.
• Take your medicine according to the
directions.
 Tips for safe medication use
• Talk to your doctor or pharmacist if you do
not want to take your medicines or cannot
take them.
• Tell your doctor about any changes in your
health.
• Tell your doctor if any medicine makes you
feel better or worse.
• Throw away medicines that are out of date.
• Do not share medicines with family or
friends
Prescribed medication that can cause
falls
Parkinson's
disease
•Pain
•Seizures
Aggression
•Sleep
Schizophrenia
•Anxiety
Parkinsons
•Nerves Heart problems
Swelling
Blood pressure
Urinary accidents
Epilepsy Cramps
Mood Muscle
Depression spasms
Painkillers
Antihistamines
Over the counter medicines that can
cause falls

Painkillers (ibuprofen, Cold and flu Allergy tablets

naproxen) (pseudoephedrine, (chlorpheniramine,
phenylepherine) promethazine)

Heartburn tablets Sleeping tablets

(ranitidine, cimetidine, (diphenhydramine e.g
famotidine) Nytol )
 • CASE STUDY
Mr M
89 years old male
Wife recently passed
away
Dosette box contains:
•Bisoprolol 10mg
•Clopidogrel 75mg
•Ramipril 10mg
•Furosemide 40mg
•Mirtazepine 45mg
•Aspirin 75mg
Mr M also buys Nytol from his chemist. Since
•Simvastatin 40mg his wife passed away he has difficulty
sleeping at night.
 Summary
• Falls prevention is one the aims of the NSF for
Older People
• Polypharmacy is a risk factor for falls
• Medication reviews can help to reduce the risk
of falls
• Patients at risk of osteoporosis should be on
preventative medication
• Encourage patients to use medication safely
Remember