Ladies and Gentlemen, when you enrolled in Harmony, your Harmony Team completed a comprehensive review of your medications as an essential component of your fall risk assessment and care treatment plan. The evidence is clear that medications, their side effects in isolation or combination, can increase your fall risks.
For over 20 years, physicians have been studying the relationship of medications and falls among the elderly. In a hallmark study published in 1999, physicians conducted a large-scale analysis of medications’ effect on increasing fall risk (1). From this analysis, they discovered that classes of medications have varying levels of risk. For example, diuretics increased risk of falls by 8%, partly due to issues with bladder urgency and frequency, whereas psychotropic mediations (neuroleptics, sedatives/hypnotics, antidepressants, benzodiazepines) increased risk by 73% due to even more complex side effects such as changes in cognition/confusion, drowsiness, balance and gait deficits. The increased risks associated with classes of medications has resulted in physicians, pharmacists and advance practice providers modifying medication prescriptions, educating individuals about risks, and examining side effects when administering combinations of medications which may further increase side effects. These medication review practices are very complex to safeguard you from falling while still managing medical conditions, emotional needs, health and well-being.
As the body of research has continued to advance surrounding medications and fall risks, researchers began to study the number of medications that older patients were taking, referred to as polypharmacy. In an analysis of 51 studies published in 2017 (2), 46.5% of the studies defined polypharmacy as 5 of more medications. A link was being found that with increased number of medications, health outcomes were negatively affected and falls increased. Yet, little consideration was given to the dose or duration of medications. So, the term polypharmacy has evolved from a count to having more drugs being prescribed or taken than is clinically appropriate in considering all one’s multiple medical conditions. Polypharmacy includes duplicative medications, drug-to-drug interactions, and also inadequate attention to medication effects and interactions.
There exists a large body of literature that older adults are increasingly taking large numbers of medications. So, comprehensive review of all the medications that you are taking serves as a starting point to assess their indication, efficacy and potential for benefit as well as harm when taken in combination. Indeed, you may have multiple health care conditions that require multiple medications so that complex medication management is common in older adults. As a result, many older adults may be visiting several providers, receiving multiple medications for treatment of conditions, without collaboration or coordination among providers. This scenario helps to showcase the importance of having a single Primary Care Provider to oversee and coordinate healthcare management and services but also keeping an accurate comprehensive list of all the medications you are taking.
Today, all efforts are to decrease inappropriate medications and increase appropriate medication management. Medication reconciliation became a process to help providers reach this goal with you.
Medication Reconciliation is a process of creating the most accurate list possible of ALL the medications that a person is taking – including name, dosage, frequency and route. I must emphasize again that this is a complete, accurate, and current list – all prescribed and non-prescribed medications.
This list is used to compare against other lists during all your transitions and points of care. Providers use different tools for this purpose, and may have a their own form for you to keep current medication information. In case you would like one so that you can prepare your own list, I found a tool provided by the RWJBarnabas Health System located here.
Because it is common practice in the outpatient setting for older adults to see more than one physician or prescriber for care management, another safety practice to reduce medication-related fall risks is to select one pharmacy to fill all your prescriptions.
This safe practice has been strongly recommended by pharmacists (3), a vital member of your healthcare team. By using one pharmacy, pharmacists can also identify medications that increase your fall risks, make recommendations for safer alternatives to reduce falls risk without compromising achievement of therapeutic goals, and collaborating with your prescribing providers.
I hope this message is helpful to you and provides new strategies and tools for safe medication practices that also reduce your fall risks.
As always, stay safe, strong, active, and connected with your healthcare team.
Your Harmony Team is here to help you!
Thank you for reading this message.
- Leipzig, R.M., Cumming, R.G., & Tinetti, M.E. (1999). Drugs and falls: Meta-analysis. JAGS, 47(1): 40-50
- Masoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G.E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatric, 17: 230. Accessed 091429: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/
- Fritsch, M.A., & Shelton, P.S. (2019). Geriatric polypharmacy. Pharmacist as key facilitator in assessing for fall risk: 2019 update. Clinics in Geriatric Medicine, 35: 185-204.