Strategies for prevention of medication-related falls in the elderly.

OBJECTIVE: To review the literature pertaining to the relationship between medications and fall risk in the elderly, and the role of the pharmacist in preventing falls. DATA SOURCES: A MEDLINE search was conducted to identify relevant studies, review articles, case reports, and letters in the English language published from 1985 to June 2002. Additional references were obtained from bibliographies of those articles. STUDY SELECTION: All studies evaluating the relationship between medications and falls, or the role of the pharmacist in preventing falls, that were accessible to the authors. DATA SYNTHESIS: Pharmacists have tremendous opportunities caring for patients who are considered to be at risk for a fall. Numerous drugs have been suspected of contributing to the risk of a fall. With proper identification of risk factors, the pharmacist can appropriately select medications while monitoring their efficacy and adverse effects, assist in early detection and treatment of common medical problems that contribute to falls, perform environmental-hazard assessments, provide patient and caregiver education, and suggest physical therapy and gait and balance training. Once a fall has occurred, the pharmacist can reduce the risk of a subsequent fall by reviewing medications and other risk factors, recommending drug therapy changes, and educating other health care professionals and caregivers. Interventions by pharmacists have been shown to reduce the rate of falls significantly. CONCLUSIONS AND CLINICAL APPLICATIONS: Pharmacists have many opportunities to reduce the risk of a fall. The assessment of each patient for risk factors should guide therapeutic choices for underlying diseases. Prevention of falls should be accomplished by reducing environmental risks, properly identifying and managing age-related changes in the individual, utilizing appropriate medications when warranted, and discontinuing medications that are not needed. Pharmacists can also provide valuable expertise in educating other health care professionals regarding fall risks and the appropriate usage of medications.