Falls are a common and serious health threat to adults 65 and older. Every year, more
than 1 in 4 older adults falls, but over half of those who fall won’t tell their healthcare
provider. Many of the risk factors for falls are modifiable, and pharmacists—as
members of the healthcare team—play a critical role in fall prevention.
Welcome to “STEADI: The Pharmacist’s Role in Older Adult Fall Prevention.” This
activity is a free continuing education opportunity made available through a partnership between
the Centers for Disease Control and Prevention and the American Pharmacists Association.
At that end of this application-based activity, you will have the opportunity to earn 1 hour
of CPE credit. To play the training, click the “Play”
button. You may pause at any time and can navigate using the forward and back arrows,
as available. Your progress will display in the colored bar at the top of the screen.
To turn the closed captions on or off, click here. Information on obtaining continuing
education credit is located here. We also encourage you to review the links and materials
under “Resources.” In this activity we will present how falls
are affecting the health of older adults and the steps pharmacists can take to improve
patient care, prolong independence, and ultimately save lives. After completing this activity,
pharmacists should be able to: Describe the burden of falls among older adults. Identify
health conditions and types of medications that increase fall risk. Implement fall
screening, assess risk factors, and offer prevention strategies. And discuss strategies
to improve patient care coordination for fall prevention.
In the United States, every second of every day an older adult falls.
In 2014, almost 3 million older people were treated in emergency departments for falls.
And about 20% had to be hospitalized, often for head injuries and hip fractures, and this
represents a 66% increase over the last decade. Now people are living longer, and they are
often living with chronic conditions like diabetes and arthritis. And this can increase
their risk of falling. So, we expect this problem is going to increase as time goes
on. Not only are falls and the resulting injuries
a serious threat to the health of older adults, they are costly. Annual medical costs for
falls surpass $31 billion in Medicare costs alone.
At this rate, the burden will substantially increase unless we recognize the problem and
focus on prevention. Research has found a number of ways to prevent
falls, and these are things that pharmacists and other clinicians can do to help their
patients remain healthy and live independently. When pharmacists help patients improve their
medication use and reduce their risk of falls, patients stay healthier and overall healthcare
costs are reduced. To help healthcare providers implement fall
prevention as a routine part of care, the CDC developed the Stopping Elderly Accidents,
Deaths, and Injuries (or STEADI) initiative. Based on the American and British Geriatrics
Societies’ clinical practice guideline for the prevention of falls in older persons,
STEADI provides members of the healthcare team with the tools and resources they need
to reduce their older patients’ fall risk. The role of pharmacists has been expanding.
They do everything from immunizations, to blood pressure screenings. And since
medication review is such an important part of fall prevention, they’re really uniquely
qualified to make a difference. As you provide services like chronic disease management
and other wellness services, you can reduce your patients’ fall risk. Pharmacists
are really motivated around patient safety. And with their unique set of skills and medication
review, this is a great opportunity to further collaborate and coordinate to keep our patients
safe. My role as a pharmacist, I see as expanding
beyond dispensing medications. It’s medication therapy management, increasing the patient’s
self-efficacy and working with the entire healthcare team.
I see my role in patient care as being an advocate for the patient as it relates to
the drug therapy. I want to work collaboratively with the other healthcare providers. I really
believe the pharmacist’s role should be to identify and resolve drug therapy problems. I’ve
always said and go out and promote to pharmacists that the three questions we should be asking
the patients each and every time is, “Have they reached their therapeutic outcome?” “Is
their medication safe?” “Is their medication effective?”
STEADI encourages healthcare providers, including pharmacists, to screen older adults for fall
risk, assess modifiable risk factors and intervene to reduce risk. This process is in line
with the Joint Commission of Pharmacy Practitioners, or the JCPP, Pharmacists’ Patient Care Process.
To begin preventing falls, screen patients by collecting information to identify older
adults at increased risk of falls. Assess patients to create a plan that optimizes therapies
to reduce risk. Intervene by implementing your plan and providing appropriate education
and referral. Finally, document and follow-up to improve patient care coordination. Fall
prevention can be incorporated as a routine part of care.
We incorporate fall screening into our workflow by creating a protocol. Making sure everybody’s
on board with the protocol. We have utilized certain processes, so that
we can identify potential issues that are occurring with patients before they become
issues, and we want to actually be proactive and put information into the patient profile
that might be questions we need to ask the patient to make sure they’re not having
problems. All pharmacists that provide care to older
adults have an essential role in fall prevention, no matter their practice setting. Pharmacists
in the ambulatory setting are really in a great spot to be able to help reduce falls
in their patients. First, they’re collaborating with providers and they have direct access
to the patient’s electronic medical record. So a quick review of their medication can
allow that pharmacist to make recommendations to the provider about which drugs may be increasing
the patient’s fall risk, or which drugs could be modified or reduced in order to reduce
fall risk. Pharmacists who work in the community are
seeing those patients face-to-face, and if they feel that the patient is presenting with
a wobbly balance, for example, or seems a little bit sedated, those pharmacists have
a great opportunity to interact with the patient, ask questions about their fall risk and also
to review the medications and then still provide that feedback to the patient but also the
feedback to the provider, maybe over the phone. Pharmacists who are in the discharge setting
who are sending patients home from the hospital have a great opportunity to improve their
patients’ healthcare by following up with the primary care provider if the patient was
for example admitted for a fall, or, came in with low blood pressure or some other condition
that we know increases fall risk. What they need to do is make that extra effort
to communicate that admission and that concern of the inpatient team to the patient’s primary
healthcare provider so that primary care provider can then follow up on that and identify if
that is something that the patient could in fact be at risk for in the future, and if
there are any modifications that need to be made.