FINDING BALANCE ALGORITHM
Healthcare providers should encourage older adults to carry an updated, accurate list of all their medications with them at all times (including prescription, over-the counter, vitamins, herbs and other natural health products). Falls are associated with the use of medications but the effect of the medication can be confounded by the indication. For example, a medication used to treat depression can increase the risk of falling, but depression itself is a risk factor.
In clinical practice there is continuous weighing of the relative benefits and risks of the medications that are prescribed. It may not be possible to eliminate necessary medications that increase the risk for falls. However, other interventions such as education, behavioural change and environmental modifications can be used to reduce falls risk. For example, cardiac medications may be necessary to control heart rhythm, reduce blood pressure or decrease the risk of a stroke or heart attack. However, some of these medications can cause side effects such as low blood pressure and poor balance. In this case, education about moving cautiously and changing the environment (such as placing a Sask-A-Pole by the bed) may be done.
Older clients on 4 or more prescription medications have a higher risk of falling than those taking fewer medications. However, the number is perhaps less important than considering the type, duration and dosage. All medications taken by a client at risk for falls should be assessed for the relative benefits and risks of persisting with them.
When reviewing medications, ask:
Are these drugs still required?
Is there a non-pharmacological approach for this problem?
Can the client be switched to a less hazardous medication that would have the same intended effect or could the dose being taken be reduced and still get the desired effect?
Certain types of medications are associated with an increased risk of falling: High risk medications include:
Sedative-hypnotics (e.g., benzodiazepines and other sleeping pills)
Antidepressants (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors)
Neuroleptics (also known as antipsychotics or tranquilizers).
Moderate risk medications that are more weakly associated with falls include
Cardiovascular agents (i.e. antihypertensives, anti-arrhythmic medications, beta-blockers, peripheral vasodilators, nitrates)
Controversial risks include medications such as opioids and non-steroidal anti-inflammatory drugs, as studies have found inconsistent results with these analgesics.
As noted in the Assessment section, a comprehensive medication review by a pharmacist, physician, or nurse practitioner should be conducted on all older adults identified as being at high risk for falls. Gradual withdrawal (or dosage reduction to the lowest effective dose if discontinuation is not possible) of psychotropics and other drugs associated with an increased risk of falling have been found to reduce the likelihood of further falls. Collaboration between prescribers and pharmacists is beneficial when managing the challenging task of withdrawing medications