Older adults may be unaware of their increased risk of falling. There are several risk factors for falls in older adults, including having fallen in the last six months, having an unsteady gait/balance problems, or worrying about falling. Being on three or more medications also increases risk. Promoting awareness and early screening would reduce total falls and resulting injuries, which have economic and personal costs.
Community pharmacists are highly accessible healthcare professionals, well-positioned to screen for falls risk, mitigate risk factors and promote local fall prevention programs. Community pharmacy interventions for falls prevention are not new (see attached research articles: Bartlett, Casteel, Mott); however, there are various barriers to implementation, such as time and resource constraints (see attached research article: Laliberté).
Our idea leverages pharmacist healthcare knowledge, pharmacy technology, and information dissemination to overcome barriers and provide a comprehensive intervention:
1. Healthcare knowledge
Pharmacists can use existing falls risk assessment tools such as the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths and Injuries) toolkit.
STEADI provides training for pharmacists to use these tools to screen older adults at risk and suggest mitigation strategies such as medication reviews to reduce falls risk. Medications that increase the risk of falls include antidepressants, antiepileptics, antipsychotics, diabetic medications, cardiovascular medications, opioids and sedatives. Pharmacists can assess the appropriateness of current medications and recommend withdrawing inappropriate prescriptions. For example, they may recommend that psychotropic medications be withdrawn gradually in those at risk of falling from excessive daytime drowsiness or dizziness. Pharmacists can also recommend simple interventions such as adding vitamin D as deficiency has been linked to increased falls risk (STEADI training, American Pharmacists Association).
2. healthcare technologies
Some pharmacies have health check stations that could be leveraged for falls risk screening. Currently, most health check stations in pharmacies are designed to measure and monitor sitting blood pressure only. These stations could be re-designed to integrate physical falls risk screening tests and educational materials such as:
- Including a platform with integrated force sensors that could detect sway movement and predict fall risks (stand on platform with eyes open then shut). The Wii board by Nintendo (see image below) is an example of a sensing platform technology that can assess falls (see Check Your Balance).
- A platform with force sensors could also sense standing motions during 30 Second Chair Stand Test, another test to assess falls risk.
- Re-designing the machine to measure and calculate the difference between sitting and standing blood pressures to test for postural hypotension, a known risk factor for falls in older adults.
- A flat screen TV could provide information on testing procedures, accompany or direct subjects through tests, provide test results, and direct users to follow-up with the pharmacist. When not in use, videos and other information could be displayed on the screen and/or a gaming technology could be integrated for other kinds of testing (e.g. reflexes) or to provide a fun way to learn about health.
In pharmacies without health check stations or without space for health check stations, alternative technologies could be available to assess falls risk, such as:
- A stand-alone platform with force sensors
- Wearable sensor assessment technology, such at the Kinesis QTUG™ (OpenIDEO idea in refinement stage)
3. healthcare information
Pharmacies’ information dissemination platforms could promote falls risk awareness to patients and the public. Pamphlet literature is an established way to provide information but it could also be disseminated via electronic screens, which are increasingly being integrated into pharmacy environments, in waiting and other areas.