1. Falls risk and medication
Selina Khanom : Dementia Team Pharmacist

2. Aim
To understand how medication can be a risk factor for falls

3. Objectives
Learn about the NSF for older people – what it is and why it is relevant
Understand both why and how medicines can increase risk of falls
Appreciate the importance of preventing osteoporosis in older people
Learn tips on how to use medicines safely

4. 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

5. Role of NSF The two main roles of NSFs are:
Set clear quality requirements for care based on the best available evidence of what treatments and services work most effectively for patients.
Offer strategies and support to help organisations achieve these.

6. How are NSF’s developed?
Health professionals
Patients
Carers
Health service managers
Voluntary agencies
Other experts

7. Why is the NSF for Older People relevant?
The aim of standard 6 of the NSF for Older People is to reduce the number of falls that result in serious injury and ensure effective treatment and rehabilitation for those who have fallen.

8. 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.

9. Intrinsic Risk factors
Preventing falls
Intrinsic Risk factors
Environmental
Hazards

10. 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

11. 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

12. Why is medication a risk factor?
Taking four or more medications significantly increases the risk for falling because
There are a greater number of side effects associated with multiple medication use and the side effects are often more intense
Interactions between medications can also cause side effects
Medications react differently in the body as a person ages which can increase the risk for falling

13. How medicines can cause falls
Sedation
Impaired postural stability (inability to maintain posture)
Hypotension (low blood pressure)
Drug induced parkinsonism (Parkinson like symptoms)
Visual impairment (blurred vision, dry eyes)
Hypoglycaemia (low blood sugar)
Vestibular damage (tinnitus, deafness)
Hypothermia (low body temperature)
Confusion
Dehydration

14. How medicines can cause falls
Sedation/Drowsiness
Antidepressants
Antipsychotics
Parkinsons disease medication
Impaired postural stability
Hypnotics
Sleep aids
Benzodiazpines
Postural hypotension
Diuretics

15. How medicines can cause falls
Drug induced Parkinsonism
Antipsychotics
Blurred vision/Dry eyes
Visual Impairment
Antihistamines
Drugs for urinary incontinence
Hypoglycaemia
Beta blockers
Haloperidol
Antidiabetic medication
Insulin
Quinine

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

17. 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

18. 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.

19. 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.

20. 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

21. 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

22. 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

23. 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.

24. 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

25. Prescribed medication that can cause falls
Parkinson's
disease
Pain
Seizures
Sleep
Anxiety
Nerves
Aggression
Schizophrenia
Parkinsons
Heart problems
Swelling
Blood pressure
Urinary accidents
Epilepsy
Mood
Depression
Cramps
Muscle spasms
Painkillers
Antihistamines

26. Over the counter medicines that can cause falls
Painkillers (ibuprofen, naproxen)
Cold and flu (pseudoephedrine, phenylepherine)
Allergy tablets (chlorpheniramine,
promethazine)
Heartburn tablets (ranitidine, cimetidine, famotidine)
Sleeping tablets (diphenhydramine e.g Nytol )

27. CASE STUDY 89 years old male Wife recently passed away
Mr M
CASE STUDY
89 years old male
Wife recently passed away
Dosette box contains:
Bisoprolol 10mg
Clopidogrel 75mg
Ramipril 10mg
Furosemide 40mg
Mirtazepine 45mg
Aspirin 75mg
Simvastatin 40mg
Mr M also buys Nytol from his chemist. Since his wife passed away he has difficulty sleeping at night.

28. 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

29. Remember