Post-Acute Care Pharmacy and an Interdisciplinary Approach to Fall Management

We’re more likely to fall as we age, for a variety of reasons, including decreased mobility, a lack of balance, vision difficulties—and sometimes, medications. That’s why it’s vitally important for long-term care pharmacy providers to play an active role in helping lower fall risk for Skilled Nursing Facility residents.

In the long-term care setting, the fall incidence percentage is severe—almost 50 percent. As SNF residents age, this percentage rises. The incidence rate of falls (number of falls per 100 person years) increases from 47 in older adults ages 70–74 to 121 in those that reach age 80.

It’s well known that certain medications can increase fall risk—and that post-acute care pharmacy providers play a key role in mitigating that risk. Pharmacy providers must work alongside other members of the SNF’s multidisciplinary team to help lower fall risk among all residents.
Every healthcare provider knows that medication can contribute to falls, especially in older adults. Seventy-two percent of people ages 55 and older use at least one medication, with 20.3 percent of that group using four or more.

The high rate of medication usage in this population has led to a rise in adverse drug reactions (ADRs), a particular concern for long-term care providers, who are tasked with keeping residents out of the hospital.
With a growing aging population who are being prescribed an increased number of medications, an interdisciplinary approach to fall management is vital.

Pharmacists are uniquely equipped to lend their medication expertise to the rest of the care team in order to improve resident outcomes. Let’s explore how pharmacists and post-acute care pharmacy professionals can contribute to an interdisciplinary approach to fall management.

Post-Acute Care Pharmacy Can Help Educate Residents About Medications

Healthcare professionals often assume that residents have been educated on and, as a result, understand their medications. Many healthcare providers lack the time to adequately educate residents on their medications and disease states.

The post-acute care pharmacy team can help solve these medication-related issues—they’re considered the most accessible healthcare professionals and have an intimate knowledge of medications and the potential issues they pose to residents. This knowledge can be transferred to both other members of the care team and SNF residents.

Through medication reviews and therapy management, long-term care pharmacy providers are able to reduce the chances of an older adult falling due to medication. As the pharmaceutical industry innovates, both the medications and the standard of care for disease states have become more complicated.

Resident education about both disease state and medications has taken on increased importance. Residents and care team members need to understand the purpose of each medication, its potential adverse reactions, and which medications can increase the risk of falling.

Utilizing post-acute care pharmacy services as part of your interdisciplinary approach to fall management can help provide residents with more educated supervision and care. Team members know the fall risk factors for each resident and can take steps to reduce those risks.

An issue that is especially felt in the long-term care setting is the transition of care. Poorly executed transfers of older residents from hospitals to the long-term care setting, from long-term care setting to long-term care setting, or from the long-term care setting to home carry the risk of fragmentation of care, poor clinical outcomes, inappropriate use of emergency department services, and hospital readmission.

Utilization of post-acute care pharmacy services and medication management can help provide residents with a more complete transition and help to reduce some of the errors seen in resident transition, specifically in regards to medication.

Post-Acute Care Pharmacy Can Help Monitor Polypharmacy

A major issue, especially regarding medication-related falls, is polypharmacy, or the use of multiple medications. Polypharmacy is prevalent among older adults, including those in the long-term care setting.
The Centers for Medicare & Medicaid Services implemented a quality indicator measure that targets residents on nine or more medications. A study that utilized this information found that 39.7 percent of SNF residents had polypharmacy as defined by the quality indicator measure. Residents age 85 and older represented the group with the lowest rate of polypharmacy, with nearly 35 percent of this group taking nine or more medications.

Polypharmacy has many far-reaching negative consequences, contributing to healthcare costs for both the resident and the healthcare system. There is an associated increased risk of taking a potentially inappropriate medication, an increased risk of outpatient visits, and an increased rate of hospitalization.

Post-acute care pharmacy team members can and must work with the other SNF team members to educate them on these consequences and risks—and how to mitigate them.

Polypharmacy also contributes to an increased rate of adverse drug events. In SNF residents, the rate of adverse drug events is twice as high in residents taking nine or more medications compared with those taking less.
Medication non-adherence has been associated with complicated medication regimens and polypharmacy, and can lead to potential disease progression, treatment failure, hospitalization, and adverse drug events. Polypharmacy has also been found to contribute to falls. A study found that the risk of older adults experiencing a fall rose 7 percent for each additional medication they are prescribed.

At Grane Rx, we’re committed to providing SNF residents with the utmost care—and that includes an interdisciplinary approach to fall management, including post-acute care pharmacy services. Get started working with our team today by calling (866) 824-MEDS (6337) or filling out this quick form.

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