Ashley Gay, RPh – Consultant Pharmacist

I am often asked to review resident’s medication therapy as a cause of falls. I always look for recent medication changes first but a fall can also be a sign of a new or underlying medical problem that needs treatment. Older adults who fall are at a higher risk of future falls. The following things should be checked when falls begin:

1. Assessment for new illnesses such as UTI, dehydration, anemia, pneumonia, heart problems like atrial fibrillation, or strokes.
2. Blood tests should be ordered such as urinalysis, electrolytes, glucose, complete blood counts, chest x-rays. Seizure medication levels should be tested, when applicable, to rule out toxicity. Low Vitamin D levels can also contribute to fragile bones.
3. Blood pressure and pulse readings when resident is standing and sitting. Blood pressure and cardiac medications may need to be adjusted. Low pulse is a common cause of falls. Sometimes a simple change in class of antihypertensive medications is all that’s needed.
4. Medication Review
   1. Sedatives, sleep medications, seizure medications
   2. Diabetes and Blood pressure medications
   3. Anticholinergic medications. Most commonly used for allergies, overactive bladder, vertigo, itching, certain types of antidepressants. Common examples include Benadryl, hydroxyzine, oxybutynin, dicyclomine, and amitriptyline to name a few.
   4. Opiate Pain Medications
5. Pain levels should be evaluated if gait and balance are a concern
6. Evaluation of underlying heart or neurological conditions
7. Vision Checks if not performed recently

Please don’t hesitate to contact your facilities Consultant Pharmacist if you would like a detailed review of medication therapy.