We are all too familiar with the devastating effects that a fall or hip fracture can have on a resident’s quality of life. An older woman who used to play on a bowling team and enjoy long strolls with her friends suddenly has a fall. Now, she’s bedridden and unable to meet up with her friends. It’s a sad reality that workers at senior living and other long-term care facilities work hard to prevent, and it’s one that can be improved with a team-based approach.
Numerous factors can lead to a resident falling, and one of the common reasons lies with his or her medications. Drugs, such as antihistamines and medications that affect cognitive and muscular function, can increase the risk of falls. Additionally, certain drugs are metabolized very slowly in an older adult’s system, with potentially harmful effects that can linger for days. Understanding the many, varied effects that medications have on seniors requires expertise from a pharmacist who is well-versed in medications and their ramifications.
Together with an interdisciplinary team of specialists, pharmacists can help to quickly evaluate and prevent falls. Our pharmacy team at the Mt. San Antonio Gardens life care community in Pomona, CA, recently established a program, presented at the 2020 Midyear Meeting of the American Society of Health-System Pharmacists, or ASHP, that brings together a group of specialists to address people’s needs. Through this program, we have a process by which the team performs an analysis to determine the cause of every fall, evaluates the individual’s specific needs, and then makes a recommendation to the person’s physician. Based on our input, physicians then can change medications, make appointments with the appropriate healthcare specialist, and discuss protective lifestyle changes with the resident.
From our work, we know pharmacists play a particularly important role on this team as the clinicians with the expertise to carefully evaluate the individual’s medications and to flag any potential issues. Some facilities rely on criteria developed years ago to identify high-risk drugs that should be avoided in geriatric individuals. A safer and more effective use of medications in such individuals requires a thorough assessment associated with pharmacist-provided medication therapy management, tailored to the person’s individual needs.
Many facilities depend too heavily on a person’s primary care physician to make critical decisions for individuals who have very complex needs. A regular medication review and assessment coupled with interdisciplinary input, interventions and follow-up, ensure that a physician is armed with a team of experts to help make those critical decisions, which can be life-changing for the resident.
Many older adults have several drug-related issues as well as cognitive impairment and complex needs. These factors increase the amount of expertise, time and attention required to deliver appropriate care. The pharmacist’s distinctive skillset and knowledge of prescription medications can identify problematic drugs and recommend alternative agents or preventative actions that the physician can incorporate into the patient care plan and, hopefully, drastically lower fall risk.
Senior living communities and other long-term care facilities care about their resident’ health and well-being above all else. Something as simple as ensuring that a pharmacist is a part of a team-based approach to preventing falls can change care for the better and mean the difference between a resident spending most of their time in their bed or enjoying life to the fullest.
Daniel Kudo, PharmD, is a professor at the Keck Graduate Institute, Claremont, CA, and a clinical pharmacist.
Gail Orum, PharmD, BCGP, is the associate dean of academic affairs at the Keck Graduate Institute.