Impact of enhanced pharmacologic care on the prevention of falls

A randomized controlled trial

Susan J. Blalock, Carri Casteel, Mary T. Roth, Stefanie Ferreri, Karen B. Demby, Shankar Viswanathan

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Falls are the leading cause of both fatal and nonfatal injuries among older adults in the United States. Medications that affect the central nervous system are known to increase the risk of falling. Objective: The purpose of this study was to assess the effects of a community pharmacy-based falls-prevention program targeting high-risk older adults on the rates of recurrent falls, injurious falls, and filling prescriptions for medications that have been associated with an increased risk of falling. Methods: This was a randomized controlled trial of participants recruited through a community pharmacy chain in North Carolina. The 2-year study consisted of a 1-year "look-back" period before randomization and a 1-year follow-up period after randomization. Patients were eligible to participate if they were >-65 years of age, had fallen at least once during the 1-year period preceding enrollment, and were taking medications associated with an increased risk of falling. Medications classified as high risk included benzodiazepines, antidepressants, anticonvulsants, sedative hypnotics, opioid analgesics, antipsychotics, and skeletal muscle relaxants. Participants were assigned to either the intervention arm or the control arm; participants in the intervention arm were invited to attend a faceto-face medication consultation conducted by a community pharmacy resident, whereas those in the control arm received no medication consultation. The primary end point was the rate of recurrent falls during the 1-year followup period. Secondary end points were the total number of prescriptions for high-risk medications filled during the follow-up period and either discontinued use or a reduction in the dosage of a high-risk medication during the follow-up period. Results: One hundred eighty-six patients (132 women, 54 men; 88.7% white) were enrolled. Intention-to-treat (ITT) analyses revealed no significant differences in the rates of recurrent falls, injurious falls, or filling prescriptions for high-risk medications. However, 13 patients in the intervention group either discontinued use of a high-risk medication or had the dosage reduced during the follow-up period, compared with 5 patients in the control group ( 2 = 3.94; P < 0.05). As-treated analyses revealed numeric reductions in the rates of falls (rate ratio [RR] = 0.76; 95% CI, 0.531.09), injurious falls (RR= 0.67; 95% CI, 0.431.05), and filling prescriptions for high-risk medications (RR= 0.85; 95% CI, 0.721.03) after receipt of the intervention, but the differences were not statistically significant. Conclusions: Results of this study support the feasibility of using community pharmacies to deliver a falls-prevention program targeting high-risk older adults. Although the ITT analyses revealed no significant reduction in the rate of recurrent falls, injurious falls, or overall use of high-risk medications, individuals in the intervention group were more likely than those in the control group to discontinue use of a high-risk medication or have the dosage reduced during the 1-year follow-up period. More work is needed to evaluate the intervention using a larger sample size that provides greater power to detect clinically meaningful effects of reduction in the use of high-risk medications on preventing or reducing falls in the high-risk population.

Original languageEnglish (US)
Pages (from-to)428-440
Number of pages13
JournalAmerican Journal Geriatric Pharmacotherapy
Volume8
Issue number5
DOIs
StatePublished - Oct 2010
Externally publishedYes

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Randomized Controlled Trials
Accidental Falls
Pharmacies
Prescriptions
Arm
Intention to Treat Analysis
Random Allocation
Referral and Consultation
Neuromuscular Agents
Control Groups
Feasibility Studies
Hypnotics and Sedatives
Benzodiazepines
Anticonvulsants
Sample Size
Opioid Analgesics
Antidepressive Agents
Antipsychotic Agents
Central Nervous System

Keywords

  • falls
  • medications
  • older adults
  • pharmacy
  • randomized controlled trial

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Geriatrics and Gerontology

Cite this

Impact of enhanced pharmacologic care on the prevention of falls : A randomized controlled trial. / Blalock, Susan J.; Casteel, Carri; Roth, Mary T.; Ferreri, Stefanie; Demby, Karen B.; Viswanathan, Shankar.

In: American Journal Geriatric Pharmacotherapy, Vol. 8, No. 5, 10.2010, p. 428-440.

Research output: Contribution to journalArticle

Blalock, Susan J. ; Casteel, Carri ; Roth, Mary T. ; Ferreri, Stefanie ; Demby, Karen B. ; Viswanathan, Shankar. / Impact of enhanced pharmacologic care on the prevention of falls : A randomized controlled trial. In: American Journal Geriatric Pharmacotherapy. 2010 ; Vol. 8, No. 5. pp. 428-440.
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T1 - Impact of enhanced pharmacologic care on the prevention of falls

T2 - A randomized controlled trial

AU - Blalock, Susan J.

AU - Casteel, Carri

AU - Roth, Mary T.

AU - Ferreri, Stefanie

AU - Demby, Karen B.

AU - Viswanathan, Shankar

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N2 - Background: Falls are the leading cause of both fatal and nonfatal injuries among older adults in the United States. Medications that affect the central nervous system are known to increase the risk of falling. Objective: The purpose of this study was to assess the effects of a community pharmacy-based falls-prevention program targeting high-risk older adults on the rates of recurrent falls, injurious falls, and filling prescriptions for medications that have been associated with an increased risk of falling. Methods: This was a randomized controlled trial of participants recruited through a community pharmacy chain in North Carolina. The 2-year study consisted of a 1-year "look-back" period before randomization and a 1-year follow-up period after randomization. Patients were eligible to participate if they were >-65 years of age, had fallen at least once during the 1-year period preceding enrollment, and were taking medications associated with an increased risk of falling. Medications classified as high risk included benzodiazepines, antidepressants, anticonvulsants, sedative hypnotics, opioid analgesics, antipsychotics, and skeletal muscle relaxants. Participants were assigned to either the intervention arm or the control arm; participants in the intervention arm were invited to attend a faceto-face medication consultation conducted by a community pharmacy resident, whereas those in the control arm received no medication consultation. The primary end point was the rate of recurrent falls during the 1-year followup period. Secondary end points were the total number of prescriptions for high-risk medications filled during the follow-up period and either discontinued use or a reduction in the dosage of a high-risk medication during the follow-up period. Results: One hundred eighty-six patients (132 women, 54 men; 88.7% white) were enrolled. Intention-to-treat (ITT) analyses revealed no significant differences in the rates of recurrent falls, injurious falls, or filling prescriptions for high-risk medications. However, 13 patients in the intervention group either discontinued use of a high-risk medication or had the dosage reduced during the follow-up period, compared with 5 patients in the control group ( 2 = 3.94; P < 0.05). As-treated analyses revealed numeric reductions in the rates of falls (rate ratio [RR] = 0.76; 95% CI, 0.531.09), injurious falls (RR= 0.67; 95% CI, 0.431.05), and filling prescriptions for high-risk medications (RR= 0.85; 95% CI, 0.721.03) after receipt of the intervention, but the differences were not statistically significant. Conclusions: Results of this study support the feasibility of using community pharmacies to deliver a falls-prevention program targeting high-risk older adults. Although the ITT analyses revealed no significant reduction in the rate of recurrent falls, injurious falls, or overall use of high-risk medications, individuals in the intervention group were more likely than those in the control group to discontinue use of a high-risk medication or have the dosage reduced during the 1-year follow-up period. More work is needed to evaluate the intervention using a larger sample size that provides greater power to detect clinically meaningful effects of reduction in the use of high-risk medications on preventing or reducing falls in the high-risk population.

AB - Background: Falls are the leading cause of both fatal and nonfatal injuries among older adults in the United States. Medications that affect the central nervous system are known to increase the risk of falling. Objective: The purpose of this study was to assess the effects of a community pharmacy-based falls-prevention program targeting high-risk older adults on the rates of recurrent falls, injurious falls, and filling prescriptions for medications that have been associated with an increased risk of falling. Methods: This was a randomized controlled trial of participants recruited through a community pharmacy chain in North Carolina. The 2-year study consisted of a 1-year "look-back" period before randomization and a 1-year follow-up period after randomization. Patients were eligible to participate if they were >-65 years of age, had fallen at least once during the 1-year period preceding enrollment, and were taking medications associated with an increased risk of falling. Medications classified as high risk included benzodiazepines, antidepressants, anticonvulsants, sedative hypnotics, opioid analgesics, antipsychotics, and skeletal muscle relaxants. Participants were assigned to either the intervention arm or the control arm; participants in the intervention arm were invited to attend a faceto-face medication consultation conducted by a community pharmacy resident, whereas those in the control arm received no medication consultation. The primary end point was the rate of recurrent falls during the 1-year followup period. Secondary end points were the total number of prescriptions for high-risk medications filled during the follow-up period and either discontinued use or a reduction in the dosage of a high-risk medication during the follow-up period. Results: One hundred eighty-six patients (132 women, 54 men; 88.7% white) were enrolled. Intention-to-treat (ITT) analyses revealed no significant differences in the rates of recurrent falls, injurious falls, or filling prescriptions for high-risk medications. However, 13 patients in the intervention group either discontinued use of a high-risk medication or had the dosage reduced during the follow-up period, compared with 5 patients in the control group ( 2 = 3.94; P < 0.05). As-treated analyses revealed numeric reductions in the rates of falls (rate ratio [RR] = 0.76; 95% CI, 0.531.09), injurious falls (RR= 0.67; 95% CI, 0.431.05), and filling prescriptions for high-risk medications (RR= 0.85; 95% CI, 0.721.03) after receipt of the intervention, but the differences were not statistically significant. Conclusions: Results of this study support the feasibility of using community pharmacies to deliver a falls-prevention program targeting high-risk older adults. Although the ITT analyses revealed no significant reduction in the rate of recurrent falls, injurious falls, or overall use of high-risk medications, individuals in the intervention group were more likely than those in the control group to discontinue use of a high-risk medication or have the dosage reduced during the 1-year follow-up period. More work is needed to evaluate the intervention using a larger sample size that provides greater power to detect clinically meaningful effects of reduction in the use of high-risk medications on preventing or reducing falls in the high-risk population.

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