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00:00:04.669Hi, health Mart Pharmacists From your education partner, ce Impact.
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00:00:14.528This is Game Changers and each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients.
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00:00:15.852Thanks for listening in.
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00:00:21.292I'm your host, josh Kinsey, and, as always, I'm excited about our conversation today.
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00:00:29.588Falls are one of the most serious and preventable health risks facing older adults, yet they often go unaddressed in everyday care.
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00:00:44.305In this episode, we'll talk about how pharmacists can help identify risks, educate patients and take simple steps that make a big difference in keeping patients safe and independent, and it's so great to have Kristen Meyer back as our guest for today's episode.
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00:00:45.182Kristen welcome.
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00:00:47.567Thanks, Josh, so much Glad to be back.
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00:00:48.509Yeah.
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00:01:01.024So for those of our listeners that haven't met you yet or haven't listened to one of your previous episodes, take just a couple of minutes, kristen, to tell us a little bit about yourself, and maybe your practice side, and why you're passionate about today's topic.
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00:01:02.345Sure Thanks.
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00:01:14.245So I'm a pharmacy practice professor at Drake University's College of Pharmacy and Health Sciences in Des Moines, iowa, and for the last 25 years I've been engaged in geriatric pharmacy.
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00:01:31.052So I serve patients and their caregivers and their providers just in a variety of settings assisted living, nursing home care, end-of-life care and just blessed to teach that in the classroom and with experiential students.
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00:01:36.391And the reason why I'm here today is I wanted to talk about Fall Prevention Awareness Week.
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00:01:44.022Falls are a big problem in our elderly population and I'm trying to do everything I can to increase awareness.
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00:01:45.688Yeah, that's great.
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00:01:57.977When I was on academia, on faculty, prior to this role, a couple of my colleagues were heavily involved in the fall prevention and the study project and so forth, so I'm somewhat familiar.
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00:02:05.263But honestly I'm excited about learning even more today because I don't ever think I fully grasped everything that was involved with it.
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00:02:12.709So with that, thanks again for taking time out of your busy schedule and let's just roll right into talking about Fall Prevention Week.
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00:02:19.572So tell us when it is this year and exactly kind of what it means, what it entails, the purpose of it and so forth.
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00:02:20.580Right.
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00:02:34.973So this Fall Prevention Awareness Day is coincided with the first day of fall in September, and so, yeah, so the first, so the week of September 22nd is designated as Fall Prevention Awareness Week.
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00:02:54.213This is a nationwide campaign with resources largely provided by the National Council on Aging, by the National Council on Aging and I representing the Iowa Fall Prevention Coalition and doing all that I can to increase that awareness and provide education on fall prevention.
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00:03:04.606Great, and are there activities that are planned throughout this week, like different things, like different things launch or something like that, or is it just?
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00:03:11.980go ahead.
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00:03:12.622You're shaking your head.
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00:03:13.205So, yeah, tell us sure.
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00:03:13.265Um?
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00:03:16.837So we're still in the you know um, as this podcast is require, um recorded a few months earlier than the actual event.
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00:03:27.634Um, we're still in the planning stages of many opportunities, um, but there is a fall prevention symposium that the Fall Prevention Coalition is sponsoring that week.
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00:03:34.753It's all virtual for patients, caregivers and providers to log on and learn more about fall prevention awareness.
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00:03:50.860But we're also just putting this information out here now to encourage other people to think about what they can do in their environments to improve and increase awareness, and so I've got lots of ideas today to share with people.
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00:04:06.186No matter what setting you're in, you can do something and you can collaborate with a variety of different people and providers and to increase awareness and improve people's safety yeah, that's so.
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00:04:13.544there's obviously a reason why this gets its own week and its recognition and whatever.
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00:04:17.480So I'm hesitant to learn about it because I think it's going to be dismal.
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00:04:20.790But tell us what are some of the statistics associated with falls Like?
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00:04:22.920Why is this week so important?
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00:04:25.334Right For older people.
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00:04:39.550We're considering that greater than 65-year-old population, one in four folks will have a fall in that year and falling is the number one risk factor for having a fall.
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00:04:53.151So having a history of falls puts you at great risk for having a future fall and in this older population then this is a great risk and increase for injury and hospitalization.
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00:05:02.880So, as I, as I kind of alluded to, this not only spans those of us who are more like ambulatory care environments, but think about my friend who works in trauma.
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00:05:10.346Most of the older people that she gets are, you know, head trauma and hip fractures from a fall.
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00:05:20.492So this really spans all of our practices and we're really focused on this older adult population and their increased risk for a variety of reasons.
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00:05:24.035You know frailty, but also we're going to talk about medication use as well.
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00:05:26.617Yeah, and that's what I was going to point out as well.
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00:05:31.226You know you're you're touching on not just AmCare, not just trauma.
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00:05:40.925You know inpatient, but also community pharmacies, community pharmacists as well, because you know, sometimes it is the medications that are contributing to the fall risk.
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00:05:59.093And you know, just speaking from personal experience, three of my, the three grandparents that I still had growing up, all three of them experienced a fall which led to their eventual, pretty quick death, because one was a hip break and then she just never recovered.
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00:06:00.581Another was.
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00:06:03.949It led to a cut which led to an infection which went septic.
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00:06:06.281So you know, you're right, it's just now.
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00:06:19.221They were older than 65, but still you know the risk is there and you know just the frailty of those patients the older they get, you know different things that are going on comorbidities and whatnot.
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00:06:24.423So, yeah, it's super important and I really appreciate and I'm excited to learn more.
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00:06:26.204So let's keep moving on.
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00:06:31.968So let's start with some of the things that pharmacists can do, right.
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00:06:35.971So, fall risk assessment like what does that look like?
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00:06:37.891Is that something we can do?
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00:06:41.874How difficult is that to work into our normal workflow?
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00:06:42.473Things like that?
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00:06:43.334Right.
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00:06:52.541So I highly recommend in COAs fall risk assessment the false free checkup.
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00:06:55.456I want to make sure I've got the name right, but the false free checkup is a 13 item survey.
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00:06:57.564It can be self administered.
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00:07:04.627So I mean you can just the, you can print it up and have it as a pamphlet, or you can administer it with with a patient, so you know whatever works for you.
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00:07:06.177So we've printed up a pamphlet or you can administer it with with a patient.
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00:07:07.502So, um, you know whatever works for you.
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00:07:12.704So we've printed up these pamphlets and we've had them at health fairs, but you can also put it on an ipad.
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00:07:14.427It's very interactive.
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00:07:17.300Again, it's 13 questions about their risk.
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00:07:19.187Have they fallen?
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00:07:22.577You know, what kinds of physical risk factors might they have?
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00:07:24.545What kinds of medications do they take?
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00:07:25.588It it's not real specific.
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00:07:28.189It's like do you take medicine to help you sleep?
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00:07:32.079And we'll talk about some of the variety of medications that increase risk in a minute.
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00:08:15.805So 13 questions and then it shows them why that question matters and then it follows up with some recommendations, things that they can do to decrease their fall risk, some kind of nonspecific, very general things for everyone, but also some it directs people to evidence-based fall prevention programs that may be offered in their area so that they can hook up with programs in their community to be able to, if they want to, you know, decrease their risk of falls and improve their stamina, their balance, their gait that they can seek out those programs.
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00:08:28.615Okay, so in addition to potential programs in the community, what other, I guess, like resources or answers, does it give back or suggestions of how to further reduce the risk?
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00:08:44.475Right, so it might say something like you know, ask questions about home hazards and then talk about the risk that throw rugs present.
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00:08:49.311And so keep your walkways free of throw rugs.
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00:08:52.067So that might be an example of something.
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00:09:02.625Also, if you take medicines to help you sleep, talk to your doctor or pharmacist about decreasing the use of medications that increase your fall risk.
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00:09:07.206So it kind of just directs them down each of those pathways.
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00:09:09.091Make sure that you have your vision checked.
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00:09:10.655Oh sure.
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00:09:19.125So almost the impetus for each question that's asked there's like this is why we asked it, and here's how you can sort of rectify be on the lookout for this.
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00:09:23.244Recommended practices to make it better here, got it Okay?
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00:09:26.356Yeah, I love the idea of both.
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00:09:38.302You know, making that a pamphlet that's easy for you to just kind of hand off, and then also, like you said, making it available on an iPad or on a quick laptop that you can flip around to your patient in a counseling room or something.
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00:09:42.471And it's just 13 questions, so it sounds like it would go fairly quickly.
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00:09:47.090It's not like it's an hour long discussion that you have to have with the patient on this right.
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00:09:51.307Absolutely, yeah, and and you can just send the pamphlet with the patient.
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00:09:52.009I've done that too.
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00:09:55.210You know I'm like hey, I'd like to talk to you about your fall risk.
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00:09:56.365Well, now it's not a good time.
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00:10:00.144We'll take this with you, and why don't you read it over and let's about?
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00:10:00.725it next time.
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00:10:02.288I see you, yeah, yeah.
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00:10:08.816You know, and I'm, you know and you can you kind of know who your targets are in your practice.
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00:10:13.731You know it's maybe that person picking up a prescription for their sleep medication.
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00:10:18.821You know it may be a person who's come in to see you after a fall, you know.
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00:10:22.837I was going to say it may be someone that you, you know, have experienced falls already.
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00:10:23.681Yeah, Right yeah, Right yeah.
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00:10:47.403There's no greater time, no greater motivation than to talk to a person about their fall risk after they've had a fall you know and fear of falling also a risk factor for falling, and I've seen that you know a person might change their gait or I've had someone describe to me you know I'm very careful change their gait, or I've had someone describe to me you know I'm very careful.
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00:10:56.605Well, with that, you change your gait and you're not quite as balanced and steady and strong to maintain your balance.
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00:11:03.226Almost because of like a nervous expectation like you're yeah, interesting, very interesting, okay.
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00:11:18.692So we talked about this is something that pharmacists can easily do with their at-risk patients and a couple of ways in which that makes sense, whether it's, you know, in your workflow, ask them to step into your counseling room to talk about it, or scheduling an appointment with them, or sending it home with them.
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00:11:35.570So you also mentioned a few things that it's going to recommend about, like ways to decrease falls, fall risks, but let's, let's go into more opportunities that you know we can talk about with our patients to decrease the risk of falls.
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00:11:39.682I know there's the list could go on and on and on, but let's just talk about a few of those, if you want.
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00:11:42.806Sure, yeah, and you, you're right.
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00:11:49.772The list can go on and on, but some of the things you know, I encourage folks to stay as active as possible.
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00:12:18.730So, you know, and I don't I don't want to be tone deaf and saying, hey, you know you need to increase your exercise, but you know more phrasing it like, stay as active as you're able to or do as much as you're, you know, physically possible to, you know, or if you want to increase your abilities and this is where the idea of collaboration comes in, you know, suggest to them maybe going to physical therapy, you know.
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00:12:19.131And.
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00:12:47.322And then from the medication standpoint, you know, looking at those opportunities to deprescribe, I am reminded of it's pretty remote now, but it was just so impactful to me to think about this group in community pharmacy that researched just the impact of telling people and kind of emphasizing the risks of the benzodiazepines that they were taking.
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00:12:53.663And there was more deprescribing of benzodiazepines in the group that learned about that risk.
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00:13:03.789So just reminding folks about their risk and you don't always need the medications that you always used to need and about their changing bodies.
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00:13:21.672I mean, they're experiencing the changes and so it should be no shock to them that, as you're experiencing these changes, your kidneys are changing and you're not eliminating medicines as much as you used to, and and so we need to think about do you always need what you used to need?
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00:13:26.120And that's, that's really where the pharmacist expertise comes in.
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00:13:45.620But I also want to emphasize just, you know, making those connections as well and thinking about you know, their physical health, their eye health, their, you know, safety, driving all of those different connections that need to be made with other healthcare providers in the community as well.
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00:13:56.543Yeah, and then just some of the ones I see on here that I think are you know, you read it and you're like, well, that's common sense, but you know, again, calling it out to the patient sometimes makes a difference.
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00:14:03.311So, like reducing alcohol intake, obviously that, can you know, impair your ability to move around in a steady way.
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00:14:09.152Again, you mentioned earlier making sure that they continue to have their annual eye and hearing tests.
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00:14:13.043Same with kind of bones making sure that we're keeping the bones strong.
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00:14:18.028So scheduling any sort of tests that need to be done for that when they get of age to do so.
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00:14:21.116If you need a walker or cane, use one.
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00:14:28.927So making sure that we're taking any stigma away from that so that they're not seen, as you know, relying on something, a crutch or anything.
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00:14:31.451I love the wear the right shoes.
00:14:31.451 -->
00:14:37.721I got onto my mom about this several times when you know, when she retired and started being at home more often.
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00:14:45.091I was like you can't, you have diabetes and you can't have a foot injury and you, you know you've got to have solid shoes on because you can't slip.
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00:14:45.802You know, like you.
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00:14:47.846Just that would set you back months.
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00:14:52.221So and not the shoes you just slide into um.
00:14:52.221 -->
00:14:56.029But well, now we've got these great new invention shoes.
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00:14:59.326Right that you that still have a back on them that you have a back to it.
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00:15:11.573Yes, yeah, you just need to have a back yeah, yeah, so not not just comfy house shoes, because you know if that actually would increase your risk, because they're so easy to come off and trip over.
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00:15:22.899So yeah, but I think some of these again are just they're common sense when we sit and talk about them, but sometimes just calling it out to your patient can make a big difference, right?
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00:15:28.530So I love that list and I love the fact that it's pretty much never ending.
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00:15:42.926We could sit here for hours and think of things On NCOA's website and we'll talk about CDC resources here in a minute great handouts that are patient friendly, but also some good stuff for communicating with other providers.
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00:15:44.167That's great.
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00:15:45.846That's great.
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00:15:47.952Made a segue perfectly.
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00:15:50.258So let's jump right into CDC Steady.
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00:15:53.772So tell us what CDC Steady is, what it stands for.
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00:16:02.423It's an initiative, obviously, but let's talk a little bit about its beginning and who started it and what's overall purpose and all that good stuff.
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00:16:03.509Right.
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00:16:18.464So Steady S-T-E-A-D-I staying alive and independent for life and I had to refer to my notes because I just steady is just in my common vernacular, but launched by the CDC in 2013.
00:16:18.464 -->
00:16:59.981There's just a plethora of resources and it's really kind of aimed at patients, but also family and professional caregivers and health professionals, but also family and professional caregivers and health professionals, so there's a variety of different screening and assessment and educational resources and recommended interventions, and so there's just a ton of stuff to unpack there, and the study resources have been used in a variety of different settings that I'm familiar with and, again, they're evidence-based and really just.
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00:17:19.019So NCOA and CDC have partnered together for some of these resources, like the false free checkup assessment list, and so the purpose is just, you know, decreasing the risk of falls in our older population, and again, just lots of great resources.
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00:17:20.242That's good.
00:17:20.242 -->
00:17:35.178And for those of you that are simply listening to the episode and not sitting in front of a desk or something where you can write something down, I'm going to be sure that all of these call outs, cdc, study and NCOA, the different links and such are in the show notes.
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00:17:41.770So be sure you take a minute when you're done listening to check out the show notes and you can get quick access to all of this information.
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00:17:50.095So we mentioned earlier, obviously we're pharmacists, so we're interested in the medication component of things, right?
00:17:50.095 -->
00:17:52.843So you mentioned earlier that some medications we're pharmacists, so we're interested in the medication component of things, right?
00:17:52.843 -->
00:17:54.287So you mentioned earlier that some medications we're very familiar.
00:17:54.287 -->
00:17:59.842We should be very familiar with Beers List and some of the medications that we should be avoiding in our older patients.
00:17:59.842 -->
00:18:10.661What are some of the ones that are typically kind of related to increasing the risk of falls, like, what should we really be on the lookout for when we're looking at reducing the fall risk?
00:18:10.681 -->
00:18:14.470What should we really be on the lookout for when we're looking at reducing the fall risk.
00:18:14.470 -->
00:18:21.982Sure, yeah, and these are not going to be of any surprise to most folks, but it's the medications that can affect the CNS and have CNS side effects, right?
00:18:21.982 -->
00:18:25.711So I say, if any medication has an effect, it has a side effect.
00:18:25.711 -->
00:18:30.835So these medications you know that affect the brain think anticonvulsants.
00:18:30.835 -->
00:18:32.757These medications you know that affect the brain think anticonvulsants.
00:18:32.757 -->
00:18:45.587And obviously, as with all of these medications, some of the older medications may not be or may be more risky, may be riskier than some of the newer versions of these medications Think antidepressants.
00:18:45.587 -->
00:18:59.682So older antidepressants, very anticholinergic antidepressants like tricyclics, much more risky than some of the newer SSRIs, but they are not without risk.
00:19:00.563 -->
00:19:11.203Certainly, you know, these serotonergic medications dizziness can be a common side effect and drowsiness, and so we want to think about those things Also.
00:19:11.203 -->
00:19:28.243Antipsychotics, benzodiazepines, opioid analgesics you know we want to again employ, you know, just good patient care and practice and use the lowest doses for the shortest durations possible to help folks.
00:19:28.243 -->
00:19:41.853So sedative hypnotics, I would probably say save the best for last, because they're on my list of never, never, never, never, never use in older adults, and I think you and I went over this before.
00:19:42.314 -->
00:19:46.872you know, and I will say it again, there's not a good, safe sleep aid for older adults.
00:19:46.872 -->
00:19:49.840Um, we really need to focus on that non-farm stuff.
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00:20:01.352So that's the first thing I pick on every time and really just talk about realistic sleep expectations and the downfalls of those sleep medications in older adults.
00:20:01.352 -->
00:20:05.199So that's kind of the main list.
00:20:05.199 -->
00:20:15.183There's also potentially some issues with blood pressure medicines, but it's really only when they push the blood pressure too low.
00:20:15.930 -->
00:20:24.298Sure, and I was also going to say potentially sorry I didn't mean to interrupt you but also potentially your diabetic patients if they have a risk for hypoglycem.
00:20:24.298 -->
00:20:37.282Obviously you know de-prescribe or get rid of for a patient who's you know, got high blood pressure or diabetes.
00:20:37.282 -->
00:20:42.318But things to just be aware of with certain medications in that class too, those classes too, yeah.
00:20:42.619 -->
00:20:49.083Absolutely, and you know, and really zeroing in on those ones that are cause a greater risk for hypoglycemia than others.
00:20:49.083 -->
00:21:03.558So you know I, you know I pick on the sulfonylureas and insulin itself and you know we want to make sure that our folks are safe and people as they age they don't need as much, and so you really have to make sure.
00:21:03.558 -->
00:21:09.895Preventing hypoglycemia is really one of the greatest goals of caring for older diabetes patients.
00:21:10.836 -->
00:21:11.617Yep, absolutely.
00:21:11.617 -->
00:21:15.124And, again, a great avenue for pharmacists to be involved.
00:21:15.124 -->
00:21:17.712That's a space that we know all about.
00:21:17.712 -->
00:21:18.895We can be in that space.
00:21:18.895 -->
00:21:26.061We can determine whether or not a medication needs to decrease or whether or not, you know, insulin is not as needed as it was previously.
00:21:26.061 -->
00:21:28.792So and you get, you know, again, that's common sense.
00:21:28.792 -->
00:21:38.300You're thinking about those patients oftentimes are reducing their overall body weight, you know, because of a decreased appetite and you know things like that.
00:21:38.300 -->
00:21:46.601So, and not eating scheduled meals or at the right times, I know, you know that those are things that we have to look at as well.
00:21:46.601 -->
00:21:47.792So, again, common sense.
00:21:47.792 -->
00:21:51.471But it's good to call them out and just make sure that we're on the same page with that.
00:21:51.471 -->
00:21:55.063So we've mentioned beers criteria.
00:21:55.063 -->
00:21:57.369Obviously there's some overlap there.
00:21:57.369 -->
00:22:05.252So a lot of those medications that you mentioned for falls risk, those are a lot of the similar ones, if not all of them are on beers criteria, probably.
00:22:05.252 -->
00:22:06.314So anything else?
00:22:06.314 -->
00:22:07.193Yeah, there's an excellent resource.
00:22:07.193 -->
00:22:07.795Anything else to speak to?
00:22:07.815 -->
00:22:16.803Yeah, beers is an excellent resource to just you know, educate yourself about the risky meds and also to learn you know.
00:22:16.803 -->
00:22:31.845It gives more information about why they're risky and also when we think about not just identifying the pharmacist as the medication expert, not only identifying what's risky, but thinking about what may be a better alternative.
00:22:32.190 -->
00:22:32.811Sure Yep.
00:22:33.051 -->
00:22:36.342Yeah, don't identify a problem without offering a solution.
00:22:37.150 -->
00:22:41.221Exactly what's going to happen if I suggest to the provider to take them off of this.
00:22:41.221 -->
00:22:43.413I need to have a response ready.
00:22:43.413 -->
00:22:45.277So, yeah, great, great, call out.
00:22:45.277 -->
00:22:55.622And if you're interested in learning more about Beers Criteria, be sure to go back and check out the episode that Kristen did with us a while back specifically on the topic.
00:22:55.622 -->
00:23:05.336So be sure that that's something is a great compliment to the discussion that we're having today as well, especially if it piques your interest and you want to be sure that you're checking all of your patients for fall risk.
00:23:06.131 -->
00:23:13.157So let's shift to again what we've already kind of talked about this a little bit, but just to reiterate our role as collaborators.
00:23:13.157 -->
00:23:25.073So again, we know we're the medication experts, but our role also is often to collaborate with other providers and make sure that our suggestions, our ideas, our call-outs are carried through to fruition.
00:23:25.073 -->
00:23:29.894So what are some of the things that we should let prescribers know in the process of identifying patients at risk?
00:23:29.894 -->
00:23:38.519Or things that we should let prescribers know in the process of identifying patients at risk, or things that we think should happen to keep their risk low?
00:23:39.279 -->
00:23:40.001Sure, yeah.
00:23:40.001 -->
00:23:45.898So again I said, you know, don't identify a problem without offering a solution.
00:23:45.898 -->
00:23:49.432So think about you know, okay, this med is risky.
00:23:49.432 -->
00:23:55.496So in collaboration with the patient, you know what could we do that maybe decreases their risks.
00:23:55.496 -->
00:23:57.240So could we decrease the dose?
00:23:57.240 -->
00:24:00.255Are they willing to work to discontinuation?
00:24:00.255 -->
00:24:02.741And sometimes that may, you know, require some tapering?
00:24:02.741 -->
00:24:15.137Most medications that happen to be psychotropic or the patient will have a better time and more success if they slowly taper off those medications rather than stopping them.
00:24:15.137 -->
00:24:17.122Cold Turkey and um.
00:24:17.122 -->
00:24:20.035We want to have a successful tapering and discontinuation.
00:24:20.035 -->
00:24:31.996So reducing, stopping, switching, um, all of those things, um would be things that you would have to collaborate with, not only the prescriber but the patient, if that patient's not buying in, it's not happening.
00:24:33.818 -->
00:24:50.203And also, I might add, if I go to a prescriber and I say Mrs Smith is concerned about the number of medications she takes, mrs Smith had a fall and she would like to explore decreasing this medicine which can increase her risk for falls.
00:24:50.203 -->
00:25:03.619Everybody wants to do what's best for Mrs Smith, so you're not going to have too much argument about that and trying to affect change if everybody's on board about doing what's best for Mrs Smith.
00:25:04.201 -->
00:25:07.112You can try to frame that with the patient in mind.
00:25:07.693 -->
00:25:13.472Exactly, and I think it boils down to again having a plan, not just saying this is ridiculous.
00:25:13.472 -->
00:25:14.494The list is so long.
00:25:14.494 -->
00:25:15.438Get rid of some stuff.
00:25:15.438 -->
00:25:17.321You need to have a plan.
00:25:17.321 -->
00:25:20.195Suggest things, make suggestions for the switch.
00:25:20.256 -->
00:25:30.612If you're saying one of these doesn't work anymore, you've got to have an option if it's something that they must be on a medication, in a class or similar class.
00:25:30.612 -->
00:25:35.662So one of the things I want to jump into now is talking a little bit more.
00:25:35.662 -->
00:25:45.904Going back to, we briefly touched on the risk assessment that you were talking about and how it would suggest things and give you ideas about things to watch out for.
00:25:45.904 -->
00:25:48.211We talked about wearing proper shoes and that kind of thing.
00:25:48.211 -->
00:25:57.832What are some of the most common household hazards that, if we only have a second to talk with our patient about, we can say be aware of A, b, c and D.
00:25:57.832 -->
00:26:04.517You know what are some of those things that you feel like are easy, easy call-outs If they say I'm in a hurry, I don't have time to take your exam.
00:26:04.517 -->
00:26:09.834You know, whatever, what are some of the things that we can quickly point out to them?
00:26:10.515 -->
00:26:10.855Right.
00:26:10.855 -->
00:26:14.278So yeah, I'll go over some things that kind of hit high on my list.
00:26:14.278 -->
00:26:15.940I mentioned throw rugs.
00:26:16.461 -->
00:26:33.790you know what other trip hazards exist in the house, in the house you've lived in for 60 years, you know, or more, or whatever.
00:26:33.790 -->
00:26:34.333So do you have clutter?
00:26:34.333 -->
00:26:34.573Do you have?
00:26:34.573 -->
00:26:34.753You know?
00:26:34.753 -->
00:26:34.834How?
00:26:34.834 -->
00:26:37.840Do you, how quickly or, let's see, confidently, Can you rise from your chair?
00:26:37.840 -->
00:26:57.596I witnessed, I witnessed a loved one you know rocking back and forth in the rocking chair to kind of propel themselves out of that chair, and I thought when are you going to someday, just, you know, out into the floor and you know and face?
00:26:57.676 -->
00:27:01.911first so, you know, asking them to think about.
00:27:01.911 -->
00:27:03.555You know, how safe is your environment?
00:27:03.555 -->
00:27:06.742Do you get up in the night and go to the bathroom?
00:27:06.742 -->
00:27:11.837Is the path well lit and free of hazards?
00:27:11.837 -->
00:27:21.179Or do you have a clothes basket that you left in the, you know, in the floor, in the middle of the floor, because you, you know, just didn't get around to it?
00:27:21.179 -->
00:27:24.845Um, making sure that their furniture is functional?
00:27:24.845 -->
00:27:30.239Um, you know, maybe they need some things to hold on to here and there.
00:27:30.239 -->
00:27:32.083Um, and that's okay.
00:27:32.083 -->
00:27:37.778Um, making sure that, um, you know, how is their bedroom set up?
00:27:37.778 -->
00:27:41.613You know, for getting dressed and do they have a chair to lean on?
00:27:41.613 -->
00:27:43.376Things like that.
00:27:43.376 -->
00:27:55.476You know, and when I'm thinking about that stuff, I'm, you know, thinking about my OT friend in the back of my mind and you know, thinking about, okay, what would she say, what would she recommend?
00:27:55.476 -->
00:28:09.657And, you know, and acting as a conduit, really, you know to to maybe ask, you know, folks like, hey, do you think that you might benefit from someone coming in to help you identify?
00:28:09.718 -->
00:28:15.674some risks and some fixes in your home and sometimes, many times, those assessments can be covered by Medicare.
00:28:15.674 -->
00:28:34.155So you know, just in addition to identifying some things, but also helping people to connect with all the different resources that are available outside of medications and reducing that risk, but getting some other folks on board, so just being a connector.
00:28:36.269 -->
00:28:39.516Yeah, I love that and you know one of the use personal story.
00:28:39.516 -->
00:28:57.955Again, it took a lot to convince my mom that it was time for some grab bars in the restroom and but once we did, after a couple of falls where she had not just a black eye but a black face from like half of her face was just a complete, just terrible bruise.
00:28:57.955 -->
00:29:05.596And you know, we finally convinced her and now you know it's the best thing since sliced bread.
00:29:05.596 -->
00:29:08.492You know she's got these bars, she loves them, they're the best thing.
00:29:08.492 -->
00:29:10.340She's put them in every bathroom now.
00:29:10.340 -->
00:29:20.625So you know again, these things are just super important to again have the conversation, bring it up and make sure that your patient is thinking about it.
00:29:20.625 -->
00:29:30.021It may take some convincing, it may take a couple of times mentioning it, but a lot of these things, once they actually see them in action, will realize that it's strictly to benefit them.
00:29:31.010 -->
00:29:39.525Yeah, and with a, it's a telling honor too much, but with an aging parent, you know I'm learning a lot about these things.
00:29:39.525 -->
00:29:41.654You know things that you can travel with.
00:29:41.654 -->
00:29:51.603If you're you know if your adult child drives one of those big SUVs, you know there's a handle that you can get that helps you get in and out.
00:29:51.603 -->
00:30:15.743If you are traveling and the restroom is not equipped, you know you don't want to diminish your ability and your you know desire to travel, and so there are some portable things that are pretty inconspicuous that can be done to increase people's you know abilities and freedoms and safety.
00:30:16.810 -->
00:30:20.763Yeah, yeah, absolutely Love all of that, and freedoms and safety.
00:30:20.784 -->
00:30:22.450Yeah, yeah, absolutely Love all of that.
00:30:22.450 -->
00:30:24.913Actually, josh, that's a good segue.
00:30:24.913 -->
00:30:26.900I don't want to forget and leave out, you know we talked about our prescribing partners.
00:30:26.920 -->
00:30:34.421but and you know, and I've kind of alluded to, you know, occupational therapists, but you know when the pharmacist is working with people.
00:30:34.421 -->
00:30:37.134I mean, think about all those different resources.
00:30:37.134 -->
00:30:54.598So I want to call out, you know, the physical therapist, the occupational therapist for increasing, you know, gait, balance, strength and also home modifications, making sure that people have their vision checked regularly, referring them to podiatry if need be.
00:30:54.598 -->
00:30:57.503You know, do they have foot abnormalities?
00:30:57.503 -->
00:30:58.894You talked about diabetes.
00:30:58.894 -->
00:31:00.179Do they have neuropathy?
00:31:00.179 -->
00:31:06.923Maybe partnering with podiatrists, you know, do you offer shoe fittings in your pharmacy?
00:31:06.923 -->
00:31:13.963And making sure that people get seen and evaluated but also taken good care of.
00:31:13.963 -->
00:31:24.005And then our social work partners and different social agencies that can connect people with activities and healthy food.
00:31:24.005 -->
00:31:30.022All of those things you know super helpful connections to me.
00:31:30.470 -->
00:31:35.930Absolutely, and if you're a longtime listener of the podcast, you've heard me say it many times before.
00:31:36.530 -->
00:31:57.057But think about community health workers and you know we know, we have programs where our technicians can be our pharmacy technicians, can be cross trained as community health workers and again, those are fantastic conduits to getting some of those resources in the community I was thinking about when you were saying, like you know, this might be covered or how do they get ahold of their OT or whatever.
00:31:57.057 -->
00:32:00.844Like your CHW could be someone that really assists with that.
00:32:00.844 -->
00:32:02.214So that's the first time you've heard about it.
00:32:02.214 -->
00:32:03.018Do some research.
00:32:03.018 -->
00:32:09.797We've got a lot of training at Sea Impact that we do on that in the catalog as well, A lot of courses on CHW.
00:32:09.797 -->
00:32:13.621So another avenue that you could really tap into there.
00:32:13.621 -->
00:32:20.318So we've said this, but I'm going to have you reiterate it when should we talk to patients about fall risk?
00:32:21.703 -->
00:32:22.086All the time.
00:32:22.125 -->
00:32:23.170All the time.
00:32:23.410 -->
00:32:32.974Yeah with you know, with every new medication, with any refill, when you notice adherence issues and you know.
00:32:32.974 -->
00:32:38.993And if you note new falls, any opportunity you know that I can find.
00:32:38.993 -->
00:32:48.291You know, if a patient is expressing concerns with affordability of their medications, it's also an opportunity to deprescribe medications that may be risky.
00:32:48.291 -->
00:33:07.454So every single opportunity that you can to talk about folks, because it's really, I mean, for most people, if we're talking about one in four older adults, it's really not a question of if they will fall, but when they will fall, you know, and just mitigating all risk factors possible.
00:33:08.176 -->
00:33:09.060Yep, that's great.
00:33:09.060 -->
00:33:11.228So we've talked about some resources.
00:33:11.228 -->
00:33:18.357I'll review these again here, just briefly, but also reminding people, if you're listening, you can check out the links in the show notes.
00:33:18.357 -->
00:33:27.738But CDC and Steady, ncoa you mentioned the Falls Free Initiative and the risk assessment You've already talked about again.
00:33:27.738 -->
00:33:29.507There may be opportunities in your community.
00:33:29.507 -->
00:33:32.234So dig around in your communities, find other opportunities there.
00:33:32.234 -->
00:33:36.203What if our patients wanted resources?
00:33:36.203 -->
00:33:39.208Are there patient-specific resources that we can share back?
00:33:39.208 -->
00:33:47.279Obviously, we're going to be the ones using CDC and NCOA and things like that, but what could we share with our patients if they wanted some specific resources?
00:33:47.982 -->
00:33:58.481Right, yeah, and you have to dig around a little bit and find out what's available in your community, but certainly the idea comes to mind.
00:33:58.481 -->
00:34:05.775You know CDC should be able to link you to those community programs that are evidence-based.
00:34:05.775 -->
00:34:10.929So there are two evidence-based programs out of CDC, maybe three.
00:34:10.929 -->
00:34:29.047Actually, stepping On and Walking with Ease also Matter of balance, so there's a variety of different approaches that they use all to educate people and you know, help them get their strength, you know, and decrease their fall risk.
00:34:29.469 -->
00:34:44.117There's also so and I say this a lot often as well you know, the number one thing you can do to prevent falls is to just be stronger increase your strength and your balance, your core.
00:34:45.079 -->
00:34:48.853So there's a specific Tai Chi, tai Chi for arthritis.
00:34:48.853 -->
00:35:00.090So it's gentle, you know, smooth, purposeful movements, and there are instructors that are specifically, you know, trained to do this with older adults.
00:35:00.090 -->
00:35:11.001So Tai Chi for arthritis is is an evidence based program to decrease fall risk and so it's not, it's a gentle workout.
00:35:11.001 -->
00:35:15.541You know, I heard somebody talking about it the other day and they're like, not the kind that makes you hurt.
00:35:15.541 -->
00:35:17.835You know that's not what we're doing.
00:35:17.835 -->
00:35:22.273This is, um, just to increase movement and balance and things.
00:35:22.273 -->
00:35:25.298So another great program.
00:35:25.298 -->
00:35:30.375And also, as you know, I talked about collaborating with professionals.
00:35:30.375 -->
00:35:33.224Think about what else in your community is available.
00:35:33.224 -->
00:35:37.739So, looking at your area agencies on aging, what are are?
00:35:37.760 -->
00:35:44.619the resources available, thinking about senior centers and referring people for things like Meals on Wheels.
00:35:44.619 -->
00:35:50.731What are the local resources in your faith-based organizations?
00:35:50.731 -->
00:35:57.960I'm aware of something in my hometown where gals get together and it's a on, you know, wednesday mornings.
00:35:57.960 -->
00:36:03.065It's a social opportunity, but it's also chair.
00:36:03.065 -->
00:36:07.708I don't know it's, it's a chair workout, so it's.
00:36:07.708 -->
00:36:11.820It's simple and easy, but also increasing strength and socialization.
00:36:11.820 -->
00:36:17.114You know, what are your local home and housing services?
00:36:17.173 -->
00:36:27.152there might be, free home modifications that people can get, transportation organizations and other volunteer organizations that want to help older folks.
00:36:27.152 -->
00:36:30.052So there's just a variety of resources and it and I.
00:36:30.052 -->
00:36:34.639Once you get to looking, you'll see what's available in your community and make those connections.
00:36:34.639 -->
00:36:38.159But there's lots of great resources out there.
00:36:39.010 -->
00:36:39.492That's great.
00:36:39.492 -->
00:36:56.302Well, as we're winding down, I want to review what pharmacists can do and should do and, of course, first and foremost, look at the patient's medications, do some reviews, check for deprescribing, check for things that can be switched so that they're at a lesser risk.
00:36:56.302 -->
00:36:59.394You can also have the discussions with patients to talk about decreasing fall risk things that they can at a lesser risk.
00:36:59.394 -->
00:37:03.188You can also have the discussions with patients to talk about decreasing fall risk things that they can do around the house.
00:37:03.188 -->
00:37:06.717You can spread the word through pamphlets and handouts.
00:37:06.717 -->
00:37:15.664And assigning I keep saying assigning or giving them the exam but the assessment we'll call it.
00:37:15.664 -->
00:37:19.356I get anxious with pop quizzes or mentions, so we won't call it that.
00:37:19.356 -->
00:37:27.460And then again, as you mentioned, making sure that you're connected to your community, making sure that you're aware of the resources and things that you have for your patients.
00:37:27.541 -->
00:37:30.014So, so much that pharmacists can do.
00:37:30.014 -->
00:37:33.141Kristen, what is the last thing I'll ask you?
00:37:33.141 -->
00:37:34.952What do you think is the game changer here?
00:37:34.952 -->
00:37:39.083Like, what is our absolute take home point as pharmacists in this space?
00:37:39.769 -->
00:37:39.990Yeah.
00:37:39.990 -->
00:37:56.114So I just encourage everybody out there to take advantage of all the opportunities in September, especially the week of September 22nd, fall Prevention Awareness Week to engage with your patients you know, offering assessments, offering education, offering encouragement.
00:37:56.114 -->
00:37:58.199Engage with other providers.
00:37:58.199 -->
00:38:22.813Think about someone new that you can partner with that you maybe you haven't partnered with before to educate them and to let them know that you're a resource and a trusted resource when it comes to medication questions and then send people to them when they need to be referred and engage with your community.
00:38:22.813 -->
00:38:26.460Use those resources and education.
00:38:26.460 -->
00:38:31.978Maybe you know if you're in a community pharmacy, maybe it's a bag stuffer.
00:38:31.978 -->
00:38:38.355If you are in hospital pharmacy, you know I've taken some education pieces to my friends in the hospital.
00:38:38.355 -->
00:38:39.978They've put them in waiting rooms.
00:38:39.978 -->
00:38:45.072You know they've given them to their social workers that work with people who've had trauma.
00:38:46.396 -->
00:38:56.472There are just a variety of things that you can do to engage with patients and other providers in the community, and there's never been a better time to do it than September.
00:38:57.456 -->
00:38:58.639Yeah, I love that and that.
00:38:58.639 -->
00:39:30.115You know one thing I thought of it's more towards, probably, amcare and community practice sites, but you know you could have a little health fair on one of the days of the week fall prevention where you bring OT and PT and you bring people there, because a lot of times it's a matter of I don't know how to make the connection or I don't know where to go or you know whatever, and so if you're bringing it to them and having kind of an event at the store or at your practice site, just another way to kind of make that more available and more, you know, face forward for the patient.
00:39:30.115 -->
00:39:33.353So Absolutely, yeah, well, this is super great.
00:39:33.353 -->
00:39:39.621Kristen, Thank you so much for giving of your time and again reminding everyone to be sure that you are.
00:39:39.621 -->
00:39:41.885I guess celebrating is the right word.
00:39:41.885 -->
00:39:44.018We should celebrate it, we should promote it.
00:39:44.018 -->
00:39:47.800But Fall Prevention Week September 20th, the week of September 22nd.
00:39:47.800 -->
00:39:51.456So again, thanks, kristen, we really appreciate you giving of your time today.
00:39:51.456 -->
00:39:52.418Thank you.
00:39:55.052 -->
00:39:55.996And that's it for this week.
00:39:55.996 -->
00:40:00.242Be sure to log in to Health Mart University to claim your CE credit for this episode.
00:40:00.242 -->
00:40:02.817As always, have a great week and keep learning.
00:40:02.817 -->
00:40:03.860We'll talk to you next week.
