Participants, family members, and providers in the PACE environment should all be familiar with medications and medical conditions that increase the risk of falls. Medications—and their side effects—are one of the major causes of falls in the elderly.
Because of the potential for injury when an older person falls, everyone in the PACE environment should be aware of which medications or conditions come with an increased risk of falls.
When it’s possible, providers should seek safer alternative medications or even reduce medications to the lowest effective dose as a fall prevention strategy.
Medication Criteria in the PACE Environment
For more than 20 years, the American Geriatrics Society has provided a continuously updated resource for providers to improve the safety of older adults who take medications. The BEERS Criteria for Potentially Inappropriate Medication is the gold standard for prescribing safe medications for older adults in the PACE environment.
As PACE participants grow older, their bodies change. Because of these body changes, older adults have a higher risk of unintended or exaggerated side effects from their medications.
Each year, one out of three seniors aged 65 or older encounters at least one adverse medication reaction.
While the BEERS Criteria is a valuable tool, it cannot be the only guide when prescribing medications for participants in the PACE environment. Different participants respond differently to the same medications. Experienced clinical judgement must be included in every prescription choice.
Anticholinergic Medications in the PACE Environment
Anticholinergic medications inhibit certain nerve impulses, thereby reducing spasms of smooth muscles like those found in the bladder. These drugs are used commonly among senior adults in the PACE environment.
Some medications, such as atropine, benztropine, and oxybutynin, are used specifically for their anticholinergic properties, and others such as diphenhydramine, cyclobenzaprine, and olanzapine have anticholinergic properties unrelated to their primary use.
Studies have shown that medications with anticholinergic properties can have adverse side effects like blurred vision, dry mouth, urinary retention, constipation, cognitive impairment, confusion, delirium, increased heart rate, and drowsiness. These conditions can significantly increase the risk of falls.
The risk of falls increases when taking medications with strong anticholinergic properties, taking higher doses of these medications, or taking a combination of them. Adults in the PACE environment are also more likely to experience adverse events from anticholinergic medications because of bodily changes and preexisting conditions.
When possible, medications with anticholinergic properties should be avoided in older adults unless they are absolutely necessary. If the medication is necessary, it should be used at the lowest dose for the shortest possible time.
Providers in the PACE environment should also consider replacing such medications with alternatives, including non-medicinal solutions.
Falls in the PACE Environment
It may be impossible to eliminate falls altogether, but everyone should be concerned with reducing the risk of falls throughout the PACE environment. When a fall occurs, it is vital to evaluate the participant’s medications and determine what may have contributed to the fall.
For example, if a participant recently suffered a fall, look through recent records and see if a medication dose has been increased, a new medication has been added, or if the participant has been requesting more of a medication that could contribute to a fall.
By constantly reviewing each participant’s therapies, talking with family members, and creating action plans when a fall occurs, everyone concerned with the PACE environment can provide participants with the best care possible.
Jennifer Devinney is the Chief Clinical Officer for Grane Rx. In this role, she works with clinical pharmacists and nurses in conjunction with facility staff to develop and oversee clinical initiatives. Additionally, she is the clinical EHR integration specialist.
Categories: PACE Pharmacy