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Fall Prevention Month

The more medications a patient is on, the more likely they are to fall

By Heidi Wicks

November 2017 marks the inaugural Fall Prevention Month in Newfoundland and Labrador.

The province’s aging population is typically on multiple medications, and the more medications a patient is on, the more likely they are to fall.

Dr. Cathy Balsom (right) counsels a patient on her medications.
Photo: Chris Hammond

The Canadian Deprescribing Network cites that nearly 20 per cent of people over the age of 65 who live at home fall each year, most hospitalizations from injuries are due to falls and falls cause nine per cent of all emergency room visits.

Harmful effects of medications, such as concentration and balance problems, drowsiness, dizziness, or a drop in blood pressure may increase the risk of falls.

All of this translates into a lower quality of life and strains on the health-care system.

Falls are preventable

The good news is that many of these falls are preventable with medication assessment and counselling.

The Medication Therapy Services (MTS) Clinic in Memorial’s School of Pharmacy offers one-on-one assessments to address complex drug-related needs and can answer many questions a patient or their caretakers may have.

“We really try to clarify why they’re taking each drug, and from there, determine whether they actually need to be taking it.” — Dr. Cathy Balsom

Clinic pharmacist Dr. Cathy Balsom can break down the list of potentially harmful medications to help make medication regimes more manageable and easier to understand.

“Many of our patients and their loved ones come through our doors feeling confused and overwhelmed,” said Dr. Balsom. “So we really try to clarify why they’re taking each drug, and from there, determine whether they actually need to be taking it.

“There are three groups of medications we look out for when assessing a patient’s fall risk,” she continued. “Medications that affect the brain or “psychoactive” drugs, which can cause sedation or drowsiness; medications for blood pressure, which can cause a sudden fall in blood pressure or keep the blood pressure too low; and medications that decrease blood sugar since low blood sugar can increase the risk of a fall.”

Dr. Balsom provided a list of the drugs she frequently counsels patients on below.

  • Benzodiazepines (lorazepam, clonazepam, other medications ending in “pam”) often prescribed to help people sleep or help with anxiety
  • Other sedatives (non-benzodiazepine sedatives or “z-drugs,” such as zopiclone)
  • Antipsychotics originally used to treat schizophrenia and other illnesses with psychosis symptoms and are now used more widely to treat some symptoms of dementia and Alzheimer’s disease, as well as depression
  • Anticonvulsants/mood stabilizers originally used to treat seizures and are also used in bipolar disorder and dementia, as well as nerve pain
  • Antidepressants (including sertraline, citalopram, escitalopram, mirtazapine, venlafaxine, bupropion, amitriptyline and more)
  • Opioid (narcotic) pain relievers (codeine, hydrocodone, oxycodone, morphine, fentanyl and methadone), as they often cause drowsiness as well as other side effects
  • Anticholinergics: most over-the-counter sleeping aids (eg. Nytol, Tylenol PM) and a variety of other prescription drugs like medications for overactive bladder, nausea, itching (Benadryl) and muscle relaxants (cyclobenzaprine)
  • All blood pressure medications (Ramipril, metoprolol, amlodipine, and more), as they can sometimes decrease blood pressure too much or cause blood pressure to drop when going from sitting to standing
  • Medications for the prostate (eg. tamsulosin [Flomax and others]) can decrease blood pressure, as well
  • Medications that lower blood sugar (eg. glyburide), since low blood sugar can cause a fall
  • Anti-inflammatory drugs like ibuprofen [Advil], naproxen [Aleve] and others have also been linked to causing an increase in fall risk

Consultations at the MTS Clinic are free. Patients or their caretakers may request an appointment by calling 709-777-7491. Follow the clinic and the School of Pharmacy on Twitter @MTSClinic and @schoolofpharm and Facebook for more information on falling and other resources.

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