Medication interventions for fall prevention in the older adult

To review fall epidemiology, risk factors, assessments and intervention methods, and outcomes in order to provide guidance to pharmacists.

Recently published articles listed in Medline and resources on the Agency for Healthcare Research and Quality website (www.ahrq.gov) identified using the search terms falls, medications and falls, fall risk factors, and falls interventions and outcomes; personal data in preparation for publication consideration by the authors; and bibliographies from gathered articles.

Falls may result from multiple risk factors that should be considered to both prevent falls and intervene when a fall has occurred. Careful consideration of the total psychoactive drug load, especially psychotropic drugs, and well-planned recommendations for tapering, discontinuing, and/or replacing drugs implicated in increasing fall risk are presented. A fall risk assessment method that incorporates fall history and risk factors, current disease states and conditions, and medications that may increase fall risk is provided. Two cases with interventions and outcomes are detailed. Because anemia may increase fall risk, adequate assessment of the cause(s) of anemia and conservative recommendations to correct it may decrease fall risk. Adequate vitamin D and calcium intake also may be essential to both decrease falls and fall-related fracture risk. Suggested alternatives and tapering for drugs implicated in increasing falls are considered. Osteoporosis risk assessment is a further area requiring delineation for possible pharmacist assistance to the patient and prescriber to reduce the risk of both fall-related and nontrauma fractures. Interventions to change medications may reduce falls by up to 70%. Additional fall-related resources on the Internet are provided.

Pharmacists can play an important role by identifying patients who may have fall risk factors and history and by providing information for drug changes that may reduce fall risk.