The Role of Medication Management in Fall Prevention

In a recent blog, we took a look at medications that increase fall risk—and the role long-term care pharmacy providers play in mitigating that risk. Let’s take a deeper dive into that topic and look at why effective medication management is essential. Medication management plays a vital role in improving resident outcomes and reducing resident fall risk. In the long-term care setting, the incidence of falls is nearly 50 percent. As residents age, this number 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 age 80. It has been well documented 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 medications. The high rate of medication usage in this population has led to a rise in adverse drug reactions (ADRs), a particular concern for post-acute care pharmacy. Two-thirds of all ADR-related hospitalizations occur in those age 60 and older. ADR-related hospitalizations account for approximately 3.4–16.6 percent of all hospital admissions in older people. Unfortunately, the exact number of falls caused by medication is not known because falls are not officially recognized as an ADR. With a growing aging population and increased prescribing of medication to older adults, proper medication management and education is vital. Pharmacists are uniquely equipped to lend their medication expertise to improve resident outcomes. Each day, 74 older adults die from fall-related injuries, which equates to 27,000 deaths per year. Most startling is that one out of five falls result in a serious outcome such as a fracture or a head injury. In fact, more than 95 percent of hip fractures are caused by falls. These statistics help paint a picture of how serious falls are, especially in older adults, but don’t show us how to prevent them. The utilization of pharmacists and LTC pharmacy services can have a profound outcome on a resident’s health and help to reduce resident falls.

Medication Management Keeps an Eye on Polypharmacy

A major issue, especially in regards to medication-related falls, is polypharmacy, or the use of multiple medications. Polypharmacy is prevalent 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 nursing home 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 34.8 percent of this group taking nine or more medications. Polypharmacy has many far reaching negative consequences associated with it, 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. Polypharmacy also contributes to an increased rate of adverse drug events. In Skilled Nursing Facility 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. [Tweet “2 ways that #medicationmanagement plays a role in a #fallprevention plan. #LTCpharmacyservices”]

Medication Management Seeks to Help Educate Residents About Medications

Another issue is that healthcare professionals often assume that residents have been educated on and understands their medications. Many healthcare providers lack the time to adequately educate residents on their medications and disease states. Additionally, many clinical trials do not include the elderly population, and so the effects of certain medications on older adults are not entirely known. Pharmacists 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. Through medication reviews and therapy management, pharmacists 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 an increasing role of importance. Residents need to understand what each medication is for, potential adverse reactions, and which medications can increase the risk of falling. 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 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 a pharmacist or long-term 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.

How Grane Rx Can Help

Grane Rx is available to help with all of your medication-related questions or issues. A thorough medication review can be requested at any time for any residents experiencing a fall or other acute status change by utilizing the Medical Regimen Review Request Form located in your Grane Rx Policy and Procedure Manual. We’re committed to providing residents with the utmost care—and that includes using effective medication management to minimize fall risk. Get started working with our team today by calling (866) 824-MEDS (6337) or filling out this quick form.]]>

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