Preventing falls is an important public health issue as each year, one in three adults age 65 and older will suffer from a fall. These incidents not only affect the quality of life of our patients, but also have a direct impact on the healthcare system. In 2013, the total direct medical costs for falls in patients 65 and older was $34 billion (adjusted for inﬂation); these costs include hospital and nursing home care, fees for care by physicians and other healthcare professionals, rehabilitation services, the use of
medical equipment, prescription drugs, changes made to the patient’s home to help ensure their safety, and more. Additionally, many patients who experience a fall report developing a fear of falling again. This may cause them to limit their mobility and lead to a loss of physical ﬁtness, in turn increasing their risk for a subsequent fall.
As our population ages, we can expect the number of patient falls, and the impact that has on our healthcare system, to increase. However, we as pharmacists are in an excellent position to educate our patients and help prevent falls.
1. Encourage patients to be active. Exercise promotes strong muscles and better balance, which may help reduce the chances of a fall. Weight-bearing exercises, such as walking or weight training, contribute to overall strength and exercises like Tai Chi improve balance. Some patients may also beneﬁt from physical therapy.
2. Help patients keep their home safe. Make sure hazards around the house, such as clutter on the ﬂoors and stairs or wires or cables on the ﬂoor are kept to a minimum. Tape down area rugs or mats, or remove them entirely. All stairwells should have handrails and be well-lit. Install grab bars next to showers, bath tubs, and toilets, and ensure that non-slip grips are used in bathtub and shower ﬂoors.
3. Promote safe shoes. Well-ﬁtting shoes with rubber soles are best to keep patients steady on their feet, both outdoors and indoors. Discourage patients from going barefoot or wearing slippers or sandals, which may increase the chances of a fall.
4. Recommend regular eye exams. Patients should visit their eye doctor annually, or more often if they experience changes in their vision or complain of headaches, and wear prescription eyeglasses or contact lenses as prescribed.
5. Perform a medication check-up. Many common medications, both prescription and over the counter, may cause dizziness or drowsiness and increase the risk of a fall. These medications include narcotic pain medications and NSAIDs, antihypertensives, including beta blockers and diuretics, antidepressants, neuroleptics, antipsychotics, benzodiazepines, sedatives and hypnotics, urinary
agents for overactive bladder, medications for motion sickness/nausea, medications for stomach pain, heartburn, or abdominal spasms, and antihistamines. Be sure to counsel patients of this risk when starting a new medication and when changing therapy on an existing medication. Also, be sure to counsel patients on anticoagulants of the risks associated with a fall or head trauma and teach them when to seek medical care. Finally, consider alternatives when recommending OTC products in these categories to patients over 65.