Community pharmacist-led falls risk evaluation

Abstract

Older people are more likely to suffer fall-related injuries because of the multiple medications they take. Community pharmacists may screen older people with medications that increase the risk of falls and contribute to preventing potential harm through a collaborative approach. The study aimed to determine community pharmacist interventions to identify older persons at increased risk of falls because of medication use and refer them to physicians within a collaborative practice. A literature review of community pharmacy-based medication-related fall risk assessment studies was conducted. The characteristics of each tool used were compared, and a consensus on a final tool that may be applied in practice was determined through a focus group discussion. Subsequently, this identified tool was applied to screen the medication lists of 200 anonymised older persons in a community pharmacy setting. Data analysis determined the prevalence of fall risk-increasing drug (FRID) use in older adults and the feasibility of tool application. A second focus group discussion was undertaken following the piloting of the tool in the community pharmacy. The objective of the second focus group discussion was to confirm the procedures to be recommended for the application of the tool in the community pharmacy setting. The literature search generated 26 articles on the topic. Further screening resulted in ten studies utilising three fall risk assessment tools. The consensus from the focus group was to use the Medication Fall Risk Score tool. The mean age of the patients in the study was 75 years (SD=7). Almost all patients (94%, n=188) were prescribed one or more FRIDs. According to the tool criteria, 36% (n=72) of patients were at high risk of falls, requiring review by a healthcare professional. Of the 128 prescribed medications, 43% (n=55) were considered FRIDs. Most FRIDs identified belong to the medium risk group (55%, n=30). Antihypertensives (n=260) and diuretics (n=96) were the most frequently prescribed FRIDs in the population. From the second focus group discussion, the proposed toolkit outlines the following inclusion criteria as part of the fall risk evaluation service: (1) Older persons aged 65 and over, (2) those with one or more antihypertensive medications, and (3) with one or more high fall risk drugs. When adopting these criteria, of the 200 anonymised patient medication lists reviewed, 22 were classified as high fall risk individuals when the tool was used. The study provides a toolkit that could be implemented within a community pharmacy practice to identify older persons at high risk of medication-induced falls through a medication review, prompting a collaborative approach between community pharmacists and physicians.