Fall Risk

Question 1

Physiologic changes with aging that are associated with falls

Answer 1

Decreased lean body mass
Decreased myocardial sensitivity to beta-adrenergic stimulation
Decreased baroreceptor activity
Decreased cardiac output
Alterations in several aspects of cognition
Decreased respiratory muscle strength
Decreased chest wall compliance
Decreased alveolar surface, decreased vital capacity
Decreased maximal breathing capacity
Decreased accommodation of the lens of the eye (farsightedness)
Decreased conduction velocity
Osteopenia

Question 2

Nonmodifiable risk factors for falls

Answer 2

Muscle weakness
Impaired balance, mobility and ADLs, arthritis, stroke, DM, HTN, heart disease, dementia

Question 3

Modifiable risk factors for falls

Answer 3

Med use, poor foot care, unsafe footwear, impaired vision, hearing problems, unsafe environment

Question 4

Consequences of falls

Answer 4

Fear of falling, loss of confidence, mobility, and the ability to live independently, admission to hospital, eventual institutional relocation

Question 5

Drugs associated with falls

Answer 5

Sedative/hypnotics
Neuroleptics/antipsychotics
Antidepressants
BZDs
NSAIDs
Antihypertensives, diuretics- caution
Beta-blockers, narcotics- no risk

Question 6

Healthcare system barriers related to medication usage and falls

Answer 6

Providers’ lack of relevant knowledge, expertise, and/or adherence to guidelines

Geographic barriers to patients visiting HCPs and to providers’ ability to assess and improve patients’ home safety

Patients’ incomplete adoption of recommended self-management of risk-modifying behaviors

Lack of financial and organizational support required for planning, communication, and coordination among the providers of the risk-reducing healthcare, which is often needed to implement multifactorial strategies. In particular, the coordination of medication adjustment among several prescribers has proven difficult

Question 7

Strategies to get older adults aware of their fall risk

Answer 7

Increase the number of adults who have a medication review conducted by a qualified HCP at least on an annual basis; review should include an adequate focus on falls and fall-related injury prevention, with the goal of reducing, altering, or eliminating medications that increase fall risk

Conduct a strategically planned consumer education campaign to increase awareness of falls risks associated with medication use

Assure that falls self-management programs include a component on medication use and falls risk

Develop strategies to empower older adults and family members to take responsibility for medications management

Question 8

Strategies to get HCPs aware of patients’ fall risk

Answer 8

Support HCP efforts in the implementation of periodic med reviews and modifications prior to each new prescription that is written for an older adult

Develop a systematic method for predicting how various combinations of meds interact with patient characteristics to increase risk of falls, then add to existing pharmacy software to check for DDIs and CIs

Improve education of HCPs regarding the ADEs of some meds in relation to increased fall risks among older adults, and about the correct use of meds that can reduce the risks of fractures due to falls for older adults

Maximize the opportunity to address falls issues as part of MTM services within Medicare Part D benefit