North East LHIN puts focus on fall prevention

Sudbury pharmacist Lucio Fabris.

Sudbury pharmacist Lucio Fabris.

It takes a community to prevent a fall

One in three older adults fall each year, accounting for 6,400 Emergency Department visits in the North East LHIN and almost as many hospitalizations, each costing the health care system approximately $30,000.

And it’s only going to get worse as the percentage of seniors in the region increases from the current 20 per cent to 27 per cent of the population by 2026.

These were some of the scary statistics heard by 190 delegates at the North East LHIN and Partners Falls Prevention Conference in Sudbury October 27th.

“Falls are also a strong catalyst for transition to long-term care,” said Terry Tilleczek, senior director, North East LHIN. “More than one-third of seniors hospitalized due to a fall are discharged to long-term care, so given this evidence, we’re putting a keen focus on falls here in the northeast. We want to keep older adults as healthy as possible and living independently as long as they can.

The North East LHIN is using Stay on Your Feet, a best practice falls prevention strategy borrowed from Australia to help reduce the rate and severity of falls, and thousands of seniors across the region are participating in exercise classes designed to keep them healthy, mobile… and upright.

Pilot programs

There are pilot programs with family health teams to administer fall risk assessments and recruit seniors as ambassadors to spread the word to their contemporaries, home safety check lists, and partnerships with the region’s public health units to bring attention to the issue.

“We’re now expanding the conversation about fall prevention, so people my age who are concerned about the well-being and independence of our older relatives can (raise the subject)…with our mothers, fathers, aunts and uncles,” said Tilleczek.

Echoing the conference theme – it takes a community to prevent a fall – Tilleczek pointed out that hospitals, primary care providers, optometrists, pharmacists, long term care, osteoporosis experts, municipal leaders, recreation and physical activity leaders, emergency response and academia all have a role to play.

Dr. Grant McKercher, a North Bay physician specializing in care for the elderly, rhymed off a long list of risk factors, including macular degeneration, stroke, Parkinson’s, cataracts, arthritis, orthostatic hypertension and dementia.

According to McKercher, “people with moderate to severe dementia are twice as likely to fall compared to the cognitively normal and more likely to be admitted to long-term care. We don’t know precisely why, but it appears to have some relation to their ability to (focus) and their executive function.”

People with dementia aren’t able to problem solve or process information as quickly. Their awareness of self in space and their surroundings are compromised and the performance of simultaneous tasks – walking and talking, for example – competes for cognitive resources.

“What can we do to help people with cognitive impairment reduce the risk of falls?” asked McKercher.

“We can certainly implement all the strategies for the overall population, but there may also be other things we can do, including dual task training as part of an exercise program”

Pharmacological interventions, including Ritalin and Aricept – the latter for Parkinson’s patients – have also been shown to reduce the likelihood of falls.

“Medications can be very helpful for us, but they can also be quite dangerous,” Sudbury pharmacist Lucio Fabris told conference attendees.

Balancing the benefits and potential harmful effects of drugs can be very challenging, he said.

“If someone’s blood pressure is 160 over 100 and we bring it down to 120 over 80, that’s fine, but we have to be very careful with older adults because if we bring it down too low they end up getting hypotensive. They get dizzy, faint and have a fall. The same is true with diabetes. People are told they have to get their blood sugar down to 4 or 7, but if they bring it down too low, they get hypoglycemic, so it’s always a balance.”

Changing settings – from home to hospital then back to home – often leads to problems, said Fabris.

“Medications get changed and moved around, and the next thing you know, they’re taking two or three blood pressure medications.”

Fabris’ advice is for seniors to always have a list of their medications with them when they go to hospital and to review it with a nurse or doctor before returning home.

“Trust me, it will save a ton of re-admissions, problems, adverse effects and falls.”

It’s also a good idea to take advantage of the Ministry of Health’s MedsCheck program, which allows seniors to meet one-on-one with a pharmacist for a full medication review.

One review Fabris performed was for a COPD patient who was going to Emerg six or seven times per month.

“I asked him to tell me about his inhalers. He said, ‘I don’t take them.’ I looked up and there was a shelf of 40 inhalers nicely packaged. ‘This is how it works,’ he said. ‘I get my prescription. I call the pharmacy for a refill. They fill it every month so they don’t bug me. I don’t tell my doctor so he doesn’t bug me, and everything’s good.’”

Medication compliance

According to Fabris, 50 per cent of people don’t take their medications properly. In the case of the COPD patient, it was a concern about taking steroids. In other cases, people feel they are on too many drugs and arbitrarily stop taking some of them.

Uncontrolled pain can be another risk factor for falls, warned Fabris.

“When someone’s in pain, that’s their main focal point. They can’t think of anything else, so are they at risk for falls? You better believe it.

“We know that a lot of the elderly have pain, so I ask, ‘Have you tried acetaminophen?’ That’s usually step one. It’s a good drug, usually well tolerated and doesn’t have many side effects. The answer I sometimes get is ‘I tried it, it’s no good.’ How much did you take, I ask. ‘325 mg twice a day.’ Well, that’s something you give to a six-year-old, so they’re completely underdosed and haven’t given that drug a chance to work.”

Escalating to a stronger drug with codeine isn’t advisable because of the constipation it causes.

Fabris also warned about benzodiazepines, sleeping pills and prolonged use of muscle relaxers.

“Why are we putting people on some of these drugs in the first place?” he asked. “If they’re having trouble sleeping, let’s not just put them on a sleeping pill. Let’s figure out why they’re not sleeping. Maybe they’re depressed. Maybe they’re in pain. Maybe they have other conditions that are contributing to them not sleeping.

“Drug companies make a lot of money if people use drugs, but there’s not a lot of money made doing studies to show that if you did x amount of exercise, or if you lost 10 or 20 pounds, you could bring your blood pressure down five to 20 points.

Why is it that when you have a problem, you’re always given a drug for it? Lifestyle changes can be so much more effective. Drugs are always a quick fix. We need to move away from that.”

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