September 19, 2024 • 12 mins
In this episode, APhA Executive Education Fellows will discuss polypharmacy, the recent USPSTF recommendation statement on fall prevention in older adults, and some strategies and resources pharmacists can use for fall prevention.
Each month, APhA will release two, 10 to 15 minute podcasts offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care. Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).
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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Welcome to the first fill.
My name is Katie Meyer,
and I serve as the Senior Director
of content
creation here at APhA,
and I'll be the host for this episode.
This month,
we're going to try something
a little bit different,
and we'll release two different podcasts.
Today during part one,
I'm joined by APhA Executive
Education Fellows
Nicholas Bennett Brush, and Yara Al- Shaer.
(00:25):
Welcome, Nick and Yara,
why don't you introduce yourselves?
Yeah. Hi everybody.
I'm Nick Bennett Brush,
one of the Education Fellows here
at American Pharmacists
Association, a recent graduate of University
of Missouri, Kansas City School of Pharmacy.
Hello, everyone.
My name is Yara Al Shaer,
and I’m the other Education Fellow here at APhA.
(00:48):
And I'm a recent graduate from College of
Pharmacy and Health Science.
Thanks for that.
So today, during part one,
Nick, Yara
and I are going to talk a little bit
about fall prevention
and we'll discuss the recent U.S.
Preventative Services
Task Force recommendation statement
regarding interventions
to prevent falls and community
(01:08):
dwelling older adults.
During part two, I'll welcome an expert
in the field who's
serving older adults as part of his practice
to talk about interventions
and practice pearls
for pharmacists
who also serve
or are looking to serve the population.
So let's dive in.
Just a bit of background to get us started
per CDC falls are a leading cause of injury
(01:30):
among all
adults, age
65 years and older in the United States.
Looking at data from 2018 falls in older adults
lead to an estimated
3 million emergency department
visits, more than 950,000 hospitalizations
or transfers to another facility
and approximately 32,000 deaths annually.
(01:50):
And unfortunately,
the CDC also notes
that deaths from falls are increasing.
There are several
factors that contribute to a patient's
increased risk of falls as they age.
These can include things like chronic health
conditions related to falls,
functional decline
and increased use of medication.
This is obviously a major problem
(02:11):
and as pharmacists,
we are well equipped to take the lead
in fall prevention efforts,
especially that increased use of medication
risk factors.
Polypharmacy is a problem that we see every day.
This brings me to my first question.
How does the prevalence of polypharmacy
in older adults
contribute to a patient's risk of falls?
Thank you for this question.
(02:31):
So I'll first start with defining Polypharmacy,
which is the practice of taking five
or more medications at the same time.
And it's quite common among older adults.
Research, in fact, shows
that when aging individuals
are on five
or more on medications,
their risk of falling significantly increases.
Studies consistently show
a strong link
between polypharmacy and a higher risk of falls.
(02:53):
In fact, recent
data highlights that nearly 15% of older adults
who end up in the hospital due
to falls
were found to be on
a higher number of medications.
And the more medications
a patient takes, the greater
the chance of negative drug interactions.
And these include dizziness, low pressure
and confusion,
all of which makes falls more likely.
(03:13):
Additionally,
certain medications,
especially those for heart conditions,
CNS issues, pain management, endocrine disorders
can have side effects
that further increase the risk of falling.
Older adults,
especially those with multiple health
conditions, often
need to take several medications,
which puts them at even a higher risk of falling.
This is why it's crucial for pharmacist
(03:34):
to be vigilant review
and adjust medication regimens
as needed
and provide proper counseling
to help reduce this risk.
Yeah, Yara, dizziness, hypotension, confusion.
These are all certainly ideas
I've seen in my practice
when serving adults with polypharmacy.
So, Nick,
what are some suggestions
for pharmacists to identify polypharmacy
and how to intervene
(03:55):
to reduce the patient's risk of falls?
Yeah.
So pharmacists,
should perform a comprehensive medication
history with the patient
in which they identify
potentially inappropriate medications.
Things that they could look for include
duplicative therapy BEERs criteria medications
in elderly
patients, synergistic
(04:16):
effects from opioids and antidepressants
and prescribing cascades
such as edema caused by calcium channel blockers
and subsequently prescribing a diuretic rather
than being recognized as a side effect
of that calcium channel blocker.
They should also look for co-morbidities
that increase fall
risk, life expectancy
and the patient spersonal preference
(04:36):
that might allow
for deprescribing efforts that reduce risks.
And also when discussing deprescribing, the
pharmacist should do so in a
way that does not harm the patient
prescriber relationship
and emphasize that deprescribing
is recommended
to achieve the patient's health goals,
which is in this case,
the reduced risk of falling
(04:57):
and not because the patient isn't worth treating.
For example,
when a pharmacist identifies a potential patient
for deprescribing,
it would be helpful to utilize the frame
structure.
Frame is an acronym for fortify trust,
recognize the patient's willingness
or barriers to deprescribing,
align deprescribing
(05:17):
recommendations with goals of care,
manage that cognitive dissonance,
and empower
patients and caregivers
to continue the conversation with their provider.
And also, pharmacies should have a plan in place
to initiate
deprescribing safely in a stepwise manner,
and from monitoring
any symptom reoccurrence once medication
is completely discontinued.
(05:41):
So one place to look is deprescribing.org
which has some great resources
and algorithms for various disease states
and classes of medication that might be helpful.
And there are also tools
that the CDC puts out like stop, fall
and impact
that can also be helpful in evaluating
and recommending e-prescribing.
Thanks, Nick. That's all great information.
Start low and go slow is certainly my motto
(06:04):
when it comes to older adults
and I think the same applies
when you're prescribing as well.
All right, let's shift gears a little bit
and talk a little bit more about the USPSTF
recommendation statement published in June.
So, Yara,
I know you help me
take a look at that statement
and break it down a little bit.
What are some key concepts
that pharmacists should be aware of?
(06:25):
Yes. So compared to the U.S.
Preventive Services Task Force in 2018,
the new recommendation statements
didn't change too much
and still reiterate
use of exercise programs for patients
who are at higher risk of falling and suggest
offering multifactorial interventions
such as medication management
and home safety checks if appropriate.
Now, the recent U.S.
(06:46):
Preventive Services Task Force statement states
that regular exercise
has a decent impact on preventing falls
and related injuries in older adults.
However, those multifactorial interventions,
such as medication
management, vision, hearing correction,
balance and gait training
seem to only provide a small benefit
for older adults.
(07:07):
The recommendation is 2 to 3 exercise
sessions a week for a year,
and if you're wondering
what counts as enough exercise, the U.S.
Department of Health
and Human Services
and the CDC suggest getting at least 150 minutes,
that equals
two and a half hours of moderate
aerobic activity.
Or if you're more into intense workouts,
you can do
75 minutes of vigorous exercise per week.
(07:30):
And don't forget to mix
in some muscle strengthening exercise,
for example, lifting weights,
digging in a garden,
or even some yoga postures at least twice a week.
As pharmacies start
by looking at
what might be
putting your patients at risk for falls,
that could be anything from balance issues
to vision problems,
the medications they're taking,
or even how safe their home setup is.
(07:51):
Based on that,
you might recommend
some exercise a few times
a week or suggest other interventions
like reviewing their medications,
referring them to a specialist
for vision hearing,
or suggesting some changes
to their home environment.
When you're figuring out
if these medications are appropriate,
make sure you're thinking about the 4Ms
and these are what matters,
medication, mentation and mobility.
(08:13):
What matters is knowing
and aligning care with your patient,
specific health, outcome goals and preference.
Mentation is preventing,
identifying, treating
and managing dementia, depression and delirium.
Mobility is ensuring
that your patient moves safely
every day to maintain function
and do what matters to them.
And finally,
looking into their medication
if it's necessary, age friendly
(08:35):
and or does not interfere
with what matters to them,
their mobility or their mentation
across setting of care.
If you want to dive deeper
when you're working to prevent falls
with your patients,
I encourage you to head over to the CDC
for guides on fall prevention interventions.
Check out the National Institutes of Health
for information on fall prevention
or visit the USPSTF website for more information
(08:59):
or recommendations.
Thanks for
taking a little bit of time
to dive deeper
into that USPSTF statement
and really just giving a great reminder
of some general principles
as it relates to managing medications
with older adults.
For me,
the biggest takeaway here
is that even in our older adults,
we should still continue to recommend activity
(09:19):
and some form of exercise to avoid that sedentary
lifestyle, deconditioning and falls.
Nick What are some other simple suggestions
that pharmacies can make when
talking to patients they fear
might be at risk for a fall?
Yeah.
So one of the easiest things
you can recommend for your patients
is to know their space.
Loose rugs,
(09:40):
slippery surfaces
like tile floors in the bathroom
and secured
cords are all known to be increasing fall risk.
CDC again has excellent tools called STEADI-Rx
that builds
a coalition of patient pharmacists and physician
to monitor
virus in patients and make recommendations
to prevent those falls
through gait analysis, deprescribing efforts
(10:01):
and side effect management.
So another thing you can remind
your patients about
is adequate
hearing and vision
are important things to be aware of.
The ASCP falls reduction
checklist is a comprehensive tool
that accounts for medications,
medical conditions,
general patient factors, living arrangements
and sensory function in patients
as a supplement to the CDC's STEADIRx Toolkit.
(10:23):
So remind the patient
of the importance of visiting the physician
if they experience
any hearing changes or vision changes,
and to turn on lights
and keep their glasses nearby at night
if you know they're going to be getting up.
Both of these tools are simple ways
to assess polypharmacy,
prevent those prescribing cascades
I mentioned earlier,
identify those high risk medications that
are going to be really, really risky
(10:43):
for your patients
and potential synergistic effects
that lead to increased fall
risk in a clinical ambulatory
or community pharmacy setting.
Very easy
to talk to your patients
about at any given moment.
Thanks so much, Nick, for kind of tying
that together with some key best practices.
All right.
So let's summarize
major takeaways from our time here today.
(11:04):
Falls are a major cause of morbidity, morbidity
and mortality
in older adults and a contributor
as polypharmacy,
which may lead to things
like hypertension, dizziness and confusion.
Pharmacists can use their expertise
to promote safe and effective medication use,
but also offer things
like exercise interventions
and other non-pharmacological interventions
(11:24):
like removing rugs
and unsecured cords from the floor
to minimize the risk of falls.
All right, folks.
Well, that's all the time we have here today.
So look out for part
two of this month's first Fill podcast
that will release next Thursday. Teaser...
We'll be speaking with Sean Jeffrey,
a geriatric pharmacist
from the University of Connecticut.
(11:45):
I can't wait to introduce you to him.
For any BCGP
credentialed pharmacists, we've
also recently released
a case study on fall prevention,
and we also have a free case study in our library
on the 4Ms.
Check that out for sure
to earn one and a half hours
of BCGP
recertification credit toward your credential.
And last
(12:05):
but not least,
don't forget to head over
to the Learning Library
at learn.pharmacist.com
to earn your CE for this month's podcast.
We'd love to hear your feedback
on how you like the new set up.
Thanks and take care.
Welcome to the first fill.
My name is Katie Meyer,
and I serve as the Senior Director
of content
creation here at APhA,
and I'll be the host for this episode.
This month,
we're going to try something
a little bit different,
and we'll release two different podcasts.
Today during part one,
I'm joined by APhA Executive
Education Fellows
Nicholas Bennett Brush, and Yara Al- Shaer.
(00:25):
Welcome, Nick and Yara,
why don't you introduce yourselves?
Yeah. Hi everybody.
I'm Nick Bennett Brush,
one of the Education Fellows here
at American Pharmacists
Association, a recent graduate of University
of Missouri, Kansas City School of Pharmacy.
Hello, everyone.
My name is Yara Al Shaer,
and I’m the other Education Fellow here at APhA.
(00:48):
And I'm a recent graduate from College of
Pharmacy and Health Science.
Thanks for that.
So today, during part one,
Nick, Yara
and I are going to talk a little bit
about fall prevention
and we'll discuss the recent U.S.
Preventative Services
Task Force recommendation statement
regarding interventions
to prevent falls and community
(01:08):
dwelling older adults.
During part two, I'll welcome an expert
in the field who's
serving older adults as part of his practice
to talk about interventions
and practice pearls
for pharmacists
who also serve
or are looking to serve the population.
So let's dive in.
Just a bit of background to get us started
per CDC falls are a leading cause of injury
(01:30):
among all
adults, age
65 years and older in the United States.
Looking at data from 2018 falls in older adults
lead to an estimated
3 million emergency department
visits, more than 950,000 hospitalizations
or transfers to another facility
and approximately 32,000 deaths annually.
(01:50):
And unfortunately,
the CDC also notes
that deaths from falls are increasing.
There are several
factors that contribute to a patient's
increased risk of falls as they age.
These can include things like chronic health
conditions related to falls,
functional decline
and increased use of medication.
This is obviously a major problem
(02:11):
and as pharmacists,
we are well equipped to take the lead
in fall prevention efforts,
especially that increased use of medication
risk factors.
Polypharmacy is a problem that we see every day.
This brings me to my first question.
How does the prevalence of polypharmacy
in older adults
contribute to a patient's risk of falls?
Thank you for this question.
(02:31):
So I'll first start with defining Polypharmacy,
which is the practice of taking five
or more medications at the same time.
And it's quite common among older adults.
Research, in fact, shows
that when aging individuals
are on five
or more on medications,
their risk of falling significantly increases.
Studies consistently show
a strong link
between polypharmacy and a higher risk of falls.
(02:53):
In fact, recent
data highlights that nearly 15% of older adults
who end up in the hospital due
to falls
were found to be on
a higher number of medications.
And the more medications
a patient takes, the greater
the chance of negative drug interactions.
And these include dizziness, low pressure
and confusion,
all of which makes falls more likely.
(03:13):
Additionally,
certain medications,
especially those for heart conditions,
CNS issues, pain management, endocrine disorders
can have side effects
that further increase the risk of falling.
Older adults,
especially those with multiple health
conditions, often
need to take several medications,
which puts them at even a higher risk of falling.
This is why it's crucial for pharmacist
(03:34):
to be vigilant review
and adjust medication regimens
as needed
and provide proper counseling
to help reduce this risk.
Yeah, Yara, dizziness, hypotension, confusion.
These are all certainly ideas
I've seen in my practice
when serving adults with polypharmacy.
So, Nick,
what are some suggestions
for pharmacists to identify polypharmacy
and how to intervene
(03:55):
to reduce the patient's risk of falls?
Yeah.
So pharmacists,
should perform a comprehensive medication
history with the patient
in which they identify
potentially inappropriate medications.
Things that they could look for include
duplicative therapy BEERs criteria medications
in elderly
patients, synergistic
(04:16):
effects from opioids and antidepressants
and prescribing cascades
such as edema caused by calcium channel blockers
and subsequently prescribing a diuretic rather
than being recognized as a side effect
of that calcium channel blocker.
They should also look for co-morbidities
that increase fall
risk, life expectancy
and the patient spersonal preference
(04:36):
that might allow
for deprescribing efforts that reduce risks.
And also when discussing deprescribing, the
pharmacist should do so in a
way that does not harm the patient
prescriber relationship
and emphasize that deprescribing
is recommended
to achieve the patient's health goals,
which is in this case,
the reduced risk of falling
(04:57):
and not because the patient isn't worth treating.
For example,
when a pharmacist identifies a potential patient
for deprescribing,
it would be helpful to utilize the frame
structure.
Frame is an acronym for fortify trust,
recognize the patient's willingness
or barriers to deprescribing,
align deprescribing
(05:17):
recommendations with goals of care,
manage that cognitive dissonance,
and empower
patients and caregivers
to continue the conversation with their provider.
And also, pharmacies should have a plan in place
to initiate
deprescribing safely in a stepwise manner,
and from monitoring
any symptom reoccurrence once medication
is completely discontinued.
(05:41):
So one place to look is deprescribing.org
which has some great resources
and algorithms for various disease states
and classes of medication that might be helpful.
And there are also tools
that the CDC puts out like stop, fall
and impact
that can also be helpful in evaluating
and recommending e-prescribing.
Thanks, Nick. That's all great information.
Start low and go slow is certainly my motto
(06:04):
when it comes to older adults
and I think the same applies
when you're prescribing as well.
All right, let's shift gears a little bit
and talk a little bit more about the USPSTF
recommendation statement published in June.
So, Yara,
I know you help me
take a look at that statement
and break it down a little bit.
What are some key concepts
that pharmacists should be aware of?
(06:25):
Yes. So compared to the U.S.
Preventive Services Task Force in 2018,
the new recommendation statements
didn't change too much
and still reiterate
use of exercise programs for patients
who are at higher risk of falling and suggest
offering multifactorial interventions
such as medication management
and home safety checks if appropriate.
Now, the recent U.S.
(06:46):
Preventive Services Task Force statement states
that regular exercise
has a decent impact on preventing falls
and related injuries in older adults.
However, those multifactorial interventions,
such as medication
management, vision, hearing correction,
balance and gait training
seem to only provide a small benefit
for older adults.
(07:07):
The recommendation is 2 to 3 exercise
sessions a week for a year,
and if you're wondering
what counts as enough exercise, the U.S.
Department of Health
and Human Services
and the CDC suggest getting at least 150 minutes,
that equals
two and a half hours of moderate
aerobic activity.
Or if you're more into intense workouts,
you can do
75 minutes of vigorous exercise per week.
(07:30):
And don't forget to mix
in some muscle strengthening exercise,
for example, lifting weights,
digging in a garden,
or even some yoga postures at least twice a week.
As pharmacies start
by looking at
what might be
putting your patients at risk for falls,
that could be anything from balance issues
to vision problems,
the medications they're taking,
or even how safe their home setup is.
(07:51):
Based on that,
you might recommend
some exercise a few times
a week or suggest other interventions
like reviewing their medications,
referring them to a specialist
for vision hearing,
or suggesting some changes
to their home environment.
When you're figuring out
if these medications are appropriate,
make sure you're thinking about the 4Ms
and these are what matters,
medication, mentation and mobility.
(08:13):
What matters is knowing
and aligning care with your patient,
specific health, outcome goals and preference.
Mentation is preventing,
identifying, treating
and managing dementia, depression and delirium.
Mobility is ensuring
that your patient moves safely
every day to maintain function
and do what matters to them.
And finally,
looking into their medication
if it's necessary, age friendly
(08:35):
and or does not interfere
with what matters to them,
their mobility or their mentation
across setting of care.
If you want to dive deeper
when you're working to prevent falls
with your patients,
I encourage you to head over to the CDC
for guides on fall prevention interventions.
Check out the National Institutes of Health
for information on fall prevention
or visit the USPSTF website for more information
(08:59):
or recommendations.
Thanks for
taking a little bit of time
to dive deeper
into that USPSTF statement
and really just giving a great reminder
of some general principles
as it relates to managing medications
with older adults.
For me,
the biggest takeaway here
is that even in our older adults,
we should still continue to recommend activity
(09:19):
and some form of exercise to avoid that sedentary
lifestyle, deconditioning and falls.
Nick What are some other simple suggestions
that pharmacies can make when
talking to patients they fear
might be at risk for a fall?
Yeah.
So one of the easiest things
you can recommend for your patients
is to know their space.
Loose rugs,
(09:40):
slippery surfaces
like tile floors in the bathroom
and secured
cords are all known to be increasing fall risk.
CDC again has excellent tools called STEADI-Rx
that builds
a coalition of patient pharmacists and physician
to monitor
virus in patients and make recommendations
to prevent those falls
through gait analysis, deprescribing efforts
(10:01):
and side effect management.
So another thing you can remind
your patients about
is adequate
hearing and vision
are important things to be aware of.
The ASCP falls reduction
checklist is a comprehensive tool
that accounts for medications,
medical conditions,
general patient factors, living arrangements
and sensory function in patients
as a supplement to the CDC's STEADIRx Toolkit.
(10:23):
So remind the patient
of the importance of visiting the physician
if they experience
any hearing changes or vision changes,
and to turn on lights
and keep their glasses nearby at night
if you know they're going to be getting up.
Both of these tools are simple ways
to assess polypharmacy,
prevent those prescribing cascades
I mentioned earlier,
identify those high risk medications that
are going to be really, really risky
(10:43):
for your patients
and potential synergistic effects
that lead to increased fall
risk in a clinical ambulatory
or community pharmacy setting.
Very easy
to talk to your patients
about at any given moment.
Thanks so much, Nick, for kind of tying
that together with some key best practices.
All right.
So let's summarize
major takeaways from our time here today.
(11:04):
Falls are a major cause of morbidity, morbidity
and mortality
in older adults and a contributor
as polypharmacy,
which may lead to things
like hypertension, dizziness and confusion.
Pharmacists can use their expertise
to promote safe and effective medication use,
but also offer things
like exercise interventions
and other non-pharmacological interventions
(11:24):
like removing rugs
and unsecured cords from the floor
to minimize the risk of falls.
All right, folks.
Well, that's all the time we have here today.
So look out for part
two of this month's first Fill podcast
that will release next Thursday. Teaser...
We'll be speaking with Sean Jeffrey,
a geriatric pharmacist
from the University of Connecticut.
(11:45):
I can't wait to introduce you to him.
For any BCGP
credentialed pharmacists, we've
also recently released
a case study on fall prevention,
and we also have a free case study in our library
on the 4Ms.
Check that out for sure
to earn one and a half hours
of BCGP
recertification credit toward your credential.
And last
(12:05):
but not least,
don't forget to head over
to the Learning Library
at learn.pharmacist.com
to earn your CE for this month's podcast.
We'd love to hear your feedback
on how you like the new set up.
Thanks and take care.
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