It Takes Action to Prevent Falls in Older People. What Role Will You Play?

The July issue of The Senior Care Pharmacist featured two excellent articles about the essential role of pharmacists in reducing falls and falls-risk factors among older people. It is up to senior care pharmacists to contribute to a rational and balanced discussion of pharmacotherapy options, which are best achieved through a multidisciplinary approach where the pharmacist?s unique and important input can be integrated into the treatment plan.

Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice.

Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise. Public health authorities and healthcare professionals endorse the use of evidence-based, exercise-focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practice, including lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs into clinical and community practice. The practical solutions highlighted in this article can be used to address these evidence-to-practice challenges. Falls and their associated healthcare costs can be reduced by better integrating research on exercise intervention into clinical practice and community programs.

Healthy aging: programs for self-management of chronic disease second of a 2-part series.

Part 1 of this series described several healthy aging evidence-based programs and discussed collaborative opportunities for senior care pharmacists within these programs. Offered in community-based settings such as Area Agencies on Aging and senior centers, these programs focus on falls prevention, physical activity, depression management, and substance abuse prevention. This article-Part 2-explores chronic disease self-management programs (CDSMPs) that are designed to help older adults manage their chronic conditions by giving them self-confidence in their ability to control symptoms and manage the progression of their illnesses. In general, self-management programs provide older adults with education and tools to enable them to cope with chronic diseases such as diabetes, heart disease, respiratory diseases, chronic pain, and arthritis. The programs help participants handle stress, better manage their medications, discuss the benefits of and encourage physical activity and good nutrition, and communicate more effectively with health care providers, including pharmacists. Participants develop action plans related to these issues through structured planning and feedback exercises. As of January 2011, more than 70,000 older Americans have completed a CDSMP.

Healthy aging: programs that make a difference-part 1.

Health promotion and disease prevention programs are critical elements in helping older Americans remain healthy and independent. Over the past decade, the efforts of the Administration on Aging and other agencies around the country have focused on ensuring that older adults have access to community-based health promotion and disease prevention ("healthy aging") programs that can make a noticeable difference in the health and well-being of older adults. Community-based organizations and agencies that provide these healthy aging programs provide ideal partners for senior care pharmacists. Many healthy aging programs target the prevention and management of chronic conditions in which medication management plays a key role. Pharmacists who desire to work with aging service providers and serve community-dwelling older adults should be aware of these programs that are growing in importance within the aging network. This series describes several healthy aging, evidence-based programs and discusses collaborative opportunities for senior care pharmacists. Part 2 will review the concepts behind and research basis for chronic disease self-management programs for older adults and provide practice advice for pharmacists who want to collaborate with organizations that have implemented healthy aging programs.

Effect of a pharmacist-led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes.

OBJECTIVES: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality. DESIGN: Randomized cluster trial. SETTING: Twenty-five nursing homes serviced by two long-term care pharmacies. PARTICIPANTS: Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care). INTERVENTION: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review. MEASUREMENTS: Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality. RESULTS: GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35-0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72-1.09), and mortality (adjusted HR=0.88, 95% CI=0.66-1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity. CONCLUSION: Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.

Evaluation of the fleetwood model of long-term care pharmacy.

OBJECTIVES: We sought to evaluate the effectiveness of the Fleetwood Model of pharmacy practice on improving resident outcomes and hypothesized that this model would reduce potentially inappropriate medication use, hospitalizations, and death. DESIGN: Demonstration project, pre-post design. SETTING: Twelve nursing homes receiving interventions and 13 homes in the comparison group in North Carolina. PARTICIPANTS: Residents living in one of the included nursing homes from 2002 to 2004. INTERVENTION: The Fleetwood Model, performed by dispensing and consultant pharmacists, incorporated prospective reviews, direct communication with the prescribers, and formalized pharmaceutical care planning in patients at highest risk for medication-related problems. MEASUREMENTS: Hospitalizations because of potential adverse drug events, use of potentially inappropriate medications, mortality. RESULTS: Residents in the intervention had similar hospitalization rates, hospitalizations owing to potential adverse drug events, and mortality rates as residents in the usual care homes. With respect to the use of potentially inappropriate medications, the decline of use of these medications appeared earlier in the intervention homes relative to the usual care homes, but differences did not reach statistical significance (adjusted Hazard Rate = 0.86; 95% CI: 0.65-1.12). CONCLUSION: Extending the role of the dispensing and consultant pharmacists beyond federally mandated drug regimen reviews is feasible, although ability to bill and be reimbursed for such services may ensure consistent prospective intervention.

Connecting with assisted living consumers.

Connecting with residents and their family members should be considered an integral part of medication therapy management services that pharmacists provide to assisted living communities. This article provides suggestions on how pharmacists can better connect and communicate with current and future assisted-living consumers and staff to optimize medication use, maintain resident function, and help residents age in place.

Comment on medication management models and other pharmacist interventions: implications for policy and practice.

Implementation of the Medicare Modernization Act (MMA) of 2003 poses challenges for policy makers and administrators, not the least of which is a provision that high-risk or targeted beneficiaries receive Medication Therapy Management (MTM) Services. To ensure that Congressional intent is carried out when Medicare Part D goes into effect in January 2006, the Centers for Medicare & Medicaid Services (CMS) is responsible for issuing regulations to operationalize MTM Services. This article comments on the policy and practice implications of providing such services, including recommendations of the American Society of Consultant Pharmacists (ASCP) and presents findings from the Medication Management Model and other community-based Pharmacist-centered interventions as examples of solutions to improve medication management and prevent medication-related problems in Medicare beneficiaries.

Alternatives for potentially inappropriate medications in the elderly population: treatment algorithms for use in the Fleetwood Phase III Study.

OBJECTIVE: To provide estimates of the prevalence of potentially inappropriate medications used in eligible nursing facilities, to describe the development of evidence-based treatment algorithms for recommending safer alternative treatments to potentially inappropriate medications, and to provide the actual treatment algorithms developed for the Fleetwood Phase III study. DESIGN: Literature review, cross-sectional design. SETTING: Thirty North Carolina nursing facilities eligible for Fleetwood Phase III. PATIENTS, PARTICIPANTS: Algorithms developed for use by all pharmacists in the long-term care pharmacy serving the intervention facilities site for the Fleetwood Phase III study. INTERVENTIONS: Pharmacists are prospectively intervening directly with the prescriber to recommend a safer alternative to inappropriate medications using the standardized treatment algorithms developed for the study. MAIN OUTCOME MEASURE(S): Prevalence of potentially inappropriate medications used among residents and the development of 14 treatment algorithms suggesting appropriate alternatives to inappropriate medications. RESULTS: The percentage of potentially inappropriate medications used ranged from 0% to 13.2% at baseline in March 2002. We also found that evidence-based treatment algorithms were well received by consultant pharmacists at the intervention sites of the Fleetwood Phase III study. CONCLUSION: We have provided prevalence rates of potentially inappropriate medication use in nursing homes and developed treatment algorithms for pharmacists to use when making clinical recommendations regarding safer alternatives to potentially inappropriate medications in the elderly population. We are in the process of evaluating the effect of pharmacists' prospective interventions by using these standardized evidence-based treatment algorithms to reduce the prevalence of inappropriate medication use in intervention facilities.