Drugs and the Risk of Falling in the Elderly—a new guideline to prevent drug-related falls—has been launched by the BC Fall and Injury Prevention Coalition.
The guideline will assist health professionals in being proactive in the evaluation of the medications a patient is taking, ideally preventing any fall from taking place. It can also be used to assess the contribution of drugs after a fall has occurred.
This evidence-based, peer-reviewed, concise 2-page Canadian guideline is unique.
There are two main aspects to the guideline: factual information on drugs that are a concern, and conceptual perspectives on actions to be taken. While providing you with a list of drugs proven to increase the risk of falling, the guideline also emphasizes that any drug that is causing drowsiness, dizziness, hypotension, or disorders of movement or vision can increase the risk.
Importantly, this resource goes beyond other available lists of medications by including drugs that might worsen the outcome if a patient does fall. Warfarin, for example, is on the list because anticoagulants can contribute to cerebral hemorrhage if head trauma occurs when the patient falls.
Conceptually, the focus is on the individual patient. To emphasize the concept that drugs are just one of the risk factors for a fall, it is recommended that other known fall risk factors also be assessed, including balance, strength, and vision.
On each visit with elderly patients, ask if they have had a slip, trip, near fall, or fall in the past 6 months and determine if they have a mobility problem. A simple assessment checklist with these and other relevant questions is provided within the guideline to help you evaluate your patient’s risk status holistically.
The new guideline is designed for real life: there are no forbidden drugs, and there is no maximum number of allowed drugs. Instead, there are suggestions to avoid certain drugs if possible, to use the minimum effective dose, and ideally to avoid combining “risky” drugs.
The British Columbia Fall and Injury Prevention Coalition is associated with the BC Injury Research and Prevention Unit (www.injuryresearch.bc.ca) and the Centre of Excellence on Mobility, Fall Prevention and Injury in Aging (http://hiphealth.ca/CEMFIA.htm), which offer many other resources related to fall prevention on their web sites.
As well as the new medication resource, the following may be useful to you: Best Practice Guidelines for Fall Prevention in Assisted Living; the Canadian Falls Prevention Curriculum E-learning course; the SAIL program to support the elderly living in their homes; many tools to assess the risk of falling; and a pamphlet on falls for the seniors themselves.
The guideline can be found at www.hiphealth.ca/__shared/assets/Drugs_and_the_Risk_of_Falling15714.pdf.
—Barbara Cadario, BScPhm, MSc
Clinical Assistant Professor, Faculty of Pharmaceutical Sciences, UBC
—Vicky Scott, PhD, RN
Clinical Associate Professor, School of Population and Public Health, UBC
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org