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Download A Welsh overview of pharmacy and falls
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A Welsh Overview of Pharmacy and Falls Prevention Timothy Banner All Wales Consultant Pharmacist Community Healthcare Honorary Lecturer – Welsh School of Pharmacy, Cardiff University Major risk factors • • • • • History of falls Postural hypotension Alcohol Poor vision Hearing loss • • • • • Mobility/gait problems Incontinence Stroke Low morale Dementia Polypharmacy • More drugs = increased risk of falls • Increasing age, illness = increased risk of falls • Increased risk factors = increased falls How Medicines Can Cause Falls • • • • • • • • • • Sedation, drowsiness Hypoglycaemia Confusion Vestibular damage (tinnitus, deafness) Orthostatic hypotension Impaired postural stability Visual impairment (blurred vision, dry eyes) Drug induced Parkinsonism Hypothermia Dehydration Brain (psychotropic drugs) • Stopping psychotropic drugs can reduce falls (risk v benefit) • Taking a psychotropic medicine can double the risk of falling • ??? 2 or more psychotropic medicines • Due to • Drowsiness/slow reaction times • Orthostatic hypotension Heart and Circulation • In older people systolic BP of 110mmHg or less is associated with increased risk of falls. • Drugs which slow heart rate or reduce BP can cause falls. • Stopping cardiovascular medication reduces syncope and risk of falls by 50% (risk v benefit) • Aims to address some of the problems associated with the current management of polypharmacy, particularly in the frail elderly • The guideline also aims to summarise the expected effectiveness of several of the main current medicines strategies looking at: • What benefit do various medicines strategies hope to achieve? • How many patients per annum need to be treated with that medicine to obtain benefit for one patient? • Where possible, how long is it estimated that treatment was needed in therapeutic trials to show a significant difference between being on that medicine and not being on that medicine? Medication Assessments • Without assessment patients who are at high risk for falls may receive medication that will increase that risk • May be recent changes but usually medicines have been taken for a period of time without review • Older people may be more “sensitive” to medicines due to pharmacokinetic changes Role of health care team Steps required in minimizing the risks of falls – Gather all medication information of patient – Review each medication to identify any potential meds that increase falls – Monitor efficacy and adverse reactions – Make necessary adjustments to medication in relation to disease or patient’s reaction – Resist the temptation to request/prescribe additional medication to treat side effects All Healthcare Providers need to be vigilant in medication monitoring Questions for review? • Risk/Benefit ratio? • Safer drug/non-pharmacological alternative? • Minimise dose v therapeutic benefit? • Bone protection? Counselling • Taking medication at an inappropriate time can increase the risk of falls • E.g. taking diuretics late in the day, then getting up at night to go to the toilet • E.g. taking SSRIs at night, then needing night sedation Where can/do we do this? Community Pharmacy • • • • • • Accessibility Regular Contact - deliveries Advice – health campaigns Signposting MUR – Medicines Use Review DMR – Discharge Medicines Review • Limited/no access to clinical records Primary/Community Care • • • • GP practice based pharmacists Cluster pharmacists Medicines Management teams Discharge/Community resource teams • Scope to conduct medication reviews with access to clinical records Hospital Pharmacy • • • • A&E Admissions – medical/surgical Fracture clinics Rehabilitation wards • Review medication with clinical records, make changes/communicate with primary care • Medication linked to increased risk of falling • Opportunities for medication review should be maximised • Risk v benefit discussion is key to prescribing/deprescribing • Available tool to aid review • NOTEARS, STOPP/START • AWMSG guidance, Scottish guidance Thank You Any Questions? [email protected]
