1. A Welsh Overview of Pharmacy and Falls Prevention
Timothy Banner All Wales Consultant Pharmacist Community Healthcare Honorary Lecturer – Welsh School of Pharmacy, Cardiff University

5. Major risk factors History of falls Postural hypotension Alcohol
Poor vision
Hearing loss
Mobility/gait problems
Incontinence
Stroke
Low morale
Dementia

6. Polypharmacy More drugs = increased risk of falls
Increasing age, illness = increased risk of falls
Increased risk factors = increased falls

7. How Medicines Can Cause Falls
Sedation, drowsiness
Hypoglycaemia
Confusion
Vestibular damage (tinnitus, deafness)
Orthostatic hypotension
Impaired postural stability
Visual impairment (blurred vision, dry eyes)
Drug induced Parkinsonism
Hypothermia
Dehydration

8. Brain (psychotropic drugs)
Stopping psychotropic drugs can reduce falls (risk v benefit)
Taking a psychotropic medicine can double the risk of falling
??? 2 or more psychotropic medicines
Due to
Drowsiness/slow reaction times
Orthostatic hypotension

9. Heart and Circulation
In older people systolic BP of 110mmHg or less is associated with increased risk of falls.
Drugs which slow heart rate or reduce BP can cause falls.
Stopping cardiovascular medication reduces syncope and risk of falls by 50% (risk v benefit)

11. Aims to address some of the problems associated with the current management of polypharmacy, particularly in the frail elderly
The guideline also aims to summarise the expected effectiveness of several of the main current medicines strategies looking at:
What benefit do various medicines strategies hope to achieve?
How many patients per annum need to be treated with that medicine to obtain benefit for one patient?
Where possible, how long is it estimated that treatment was needed in therapeutic trials to show a significant difference between being on that medicine and not being on that medicine?

12. Medication Assessments
Without assessment patients who are at high risk for falls may receive medication that will increase that risk
May be recent changes but usually medicines have been taken for a period of time without review
Older people may be more “sensitive” to medicines due to pharmacokinetic changes
AB in Polypharmacy clinic – 86% patients on 4+ meds
Follow up with GP showed 26% had total number of medications decreased
Overall reduction in falls frequency and falls related injury was 84%

13. Role of health care team
Steps required in minimizing the risks of falls
– Gather all medication information of patient
– Review each medication to identify any potential meds that increase falls
– Monitor efficacy and adverse reactions
– Make necessary adjustments to medication in relation to disease or patient’s reaction
– Resist the temptation to request/prescribe additional medication to treat side effects
All Healthcare Providers need to be vigilant in medication monitoring

14. Questions for review? Risk/Benefit ratio?
Safer drug/non-pharmacological alternative?
Minimise dose v therapeutic benefit?
Bone protection?

15. Counselling
Taking medication at an inappropriate time can increase the risk of falls
E.g. taking diuretics late in the day, then getting up at night to go to the toilet
E.g. taking SSRIs at night, then needing night sedation

16. Where can/do we do this?

17. Community Pharmacy Accessibility Regular Contact - deliveries
Advice – health campaigns
Signposting
MUR – Medicines Use Review
DMR – Discharge Medicines Review
Limited/no access to clinical records

18. Primary/Community Care
GP practice based pharmacists
Cluster pharmacists
Medicines Management teams
Discharge/Community resource teams
Scope to conduct medication reviews with access to clinical records

19. Hospital Pharmacy A&E Admissions – medical/surgical Fracture clinics
Rehabilitation wards
Review medication with clinical records, make changes/communicate with primary care

20. Medication linked to increased risk of falling
Opportunities for medication review should be maximised
Risk v benefit discussion is key to prescribing/deprescribing
Available tool to aid review
NOTEARS, STOPP/START
AWMSG guidance, Scottish guidance

21. Thank You Any Questions?