Each year in Britain, a third of the population aged over 65 has a fall, and half of these people fall at least twice.2-5 Multiple drug-taking among elderly patients is thought to increase the incidence of falls. An estimated four out of five people over 75 years take one or more prescribed drugs.6
The study carried out at Guy's and St Thomas' NHS Foundation Trust identified that many older patients who have fallen would benefit from having their medicines reviewed to identify any which may be contributing to them being unsteady on their feet and to ensure they receive the correct medicines to help with muscle and bone strength.
During the study, patients seen by physiotherapists after a fall or who were at risk of falling were automatically referred to the pharmacy team to assess whether or not they were taking drugs which may have contributed to their fall.
On the whole, prescribing was found to be appropriate. Although 87% were taking one or more drugs that can be associated with falls, these tended to be antihypertensives, diuretics and antidepressants, drugs where the clinical benefit is weighed against the risk of falling. Few patients were taking sedatives or hypnotics which are particularly problematic in falls patients.
However, the use of vitamin D and bone protection drugs was lower. Of people who had previously suffered a fracture, just over half received bone protection drugs and around 70% were prescribed vitamin D, which helps maintain muscle function.
Pharmacist Alice Oborne, who led the research, said: "Pharmacists and physiotherapists traditionally work independently but this is a novel approach to capturing patients who fall and would benefit from medication review. Sometimes, prescribing of drugs is a risk versus benefit decision and in this case, the clinical benefits of drugs must be weighed against whether they would significantly increase the patient's risk of falling.
"Pharmacists have a vital role to play in the relationship between drugs and falls prevention. Working closely with physiotherapy to offer patients a seamless service allows us to identify prescribing issues which might otherwise be missed and evidence-based multifactorial falls interventions like these can reduce patients' chances of falling again.''
This work was conducted in collaboration with the pharmacy department of Kings College London.
Patients were identified by physiotherapists who conducted a "falls and at risk of falls" assessment during routine care, according to pre-set criteria. The data collector used a data collection form to record patients' falls history, falls risk factors (reduced gait/mobility, polypharmacy, a cardiovascular condition, visual or cognitive impairment, muscle weakness and home hazards). Data were collected for 126 inpatients.
The British Pharmaceutical Conference - entitled "The medicines maze: balancing risks and benefits " - takes place from 10th to 12th September, 2007, at Manchester Central (formerly Manchester International Convention Centre). The theme of BPC 2007 is reflected throughout the programme, with keynote speeches and workshops addressing crucial technical and professional issues that are facing pharmacy today. The conference will showcase the latest developments in pharmaceutical science and practice research and include discussion and debate led by expert speakers.
References
1. Tinetti MEet al. Guideline for the prevention of falls in older persons. J Am Geriat Soc, 2001, 49, 664-72.
2. Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical factors. Age Ageing 1981; 10: 262-270.
3. Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing 1981; 10: 141-146.
4. Lach HW, Reed AT, Arfken CL, Miller JP, Paige GD, Birge SJ, et al. Falls in the elderly: reliability of a classification system. J Am Geriatr Soc 1991; 39: 197-202[
5. Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med 1989; 320: 1055-1059[
6. Department of Health. National Service Framework for Older people. London, 2001. Available here (accessed 20th February 2006).
Royal Pharmaceutical Society of Great Britain