Tai-Chi, Fewer Meds May Prevent Falls in Elderly

Pharmacists can help seniors avoid falls by reviewing medication regimens, asking questions to assess risk, and recommending an exercise plan.

Falls among the elderly are “as serious a health problem” as heart attacks and strokes, according to new guidelines released by the American Geriatrics Society and the British Geriatric Society. Experts from both groups say getting regular exercise, cutting back on medications, and undergoing screening for fall risk can help seniors stay on their feet.

“Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence,” said Mary Tinetti, MD, of Yale University School of Medicine. She chaired the panel that drafted the new recommendations, which are based on a systematic review of clinical trials on fall prevention.

Based on their research, Dr. Tinetti and colleagues recommend a “multifactoral” approach to preventing falls. “We found that the most effective trials for preventing falls in older people looked at multiple interventions rather than just one,” she said. She recommends the following tactics for health care professionals who work with seniors:

Ask questions. Simple questions—such as “Have you fallen recently?” or “Are you having trouble walking?”—can help pharmacists and other health care professionals assess a patient’s risk of falling and take appropriate preventive steps.

Reduce medications. Even patients taking fewer than 4 drugs can benefit from a thorough review of their medications. Medications that affect the brain, such as sleeping pills or antidepressants, may be candidates for reduction in high-risk patients.

Encourage regular exercise. Seniors should focus on exercises designed to improve balance, gait, and strength. In addition to physical therapy, the guidelines recommend the gentle, focused movements of Tai Chi, a Chinese martial art.

Suggest environmental changes. Eliminating household hazards—such as slippery floors, unstable handrails, and dim lighting—substantially reduces a patient’s risk of falling at home. The Centers for Disease Control & Prevention offers this checklist for household fall prevention.

Keep health problems in check. Vision problems, low blood pressure, and heart rate abnormalities in seniors can all contribute to falls. Addressing these problems individually—through medications or surgery, where appropriate—can protect patients from serious injuries due to falls.

This multipronged approach and strong focus on prevention and screening should be standard practice in senior care, according to Dr. Tinetti.

“There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice. By making fall prevention part of the clinical care of older adults, this trend can continue,” she concluded.

For more guidance on caring for older adults, visit the following articles from the January 2011 Aging Population Issue of Pharmacy Times:

• Overactive Bladder Concerns: Urinary Incontinence Supplies
• Adherence Issues in Elderly Patients
• Bedrest: Implications for the Aging Population
• Depression: Underdiagnosed and Undertreated

For other articles in this issue, see:

• Medicare Fraud Recovery Efforts Totaled $4 Billion
• 1 in 5 Americans Have No Regular Physician