How Polypharmacy Increases Fall Risk in Older Adults
Could too many medications be causing your loved one to fall? Polypharmacy is a major risk factor in nursing homes and often goes unchecked. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Jay Durek to explain how multiple medications impact fall risk and what caregivers should be doing to prevent it.
Durek:
It can definitely depend on what symptoms or side effects that your loved one’s having from these said medications. And it can be if they’re in a facility, if they’re still at home, that’s extra work on you or whomever, something that you and your family feel necessary, then it’s definitely something that’s doable. It’s just a process of trying to figure out what puzzle pieces go where.
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I’ll be your host for this episode. Today we are talking about polypharmacy and how polypharmacy can exacerbate fall risk, and what we can do to reduce the risk of falls by reducing. Polypharmacy, but we’re not having that conversation alone.
We have the fantastic Jay Durek. Jay Durek is a Michigan born registered nurse with over 16 years of experience in med, in the medical field, including a decade in nurse nursing across hospital and outpatient settings. She’s a certified legal forensic nurse consultant. And a naturopathic practitioner blending clinical expertise with a holistic approach outside of her professional life.
For legal nurse consulting services focused on medication safety and healthcare quality, visit JDLFNC.
Jay enjoys family time with her childhood sweetheart, their son, and their beloved Mastiff, and we are so happy to have her on the show. Jay, welcome to the show.
Durek:
Hi. Thank you.
What is polypharmacy, and why is it a concern for seniors?
Schenk:
I guess the first question is gonna be what, when we say polypharmacy, what does that mean?
Durek:
So polypharmacy in. Layman’s terms are basically being on a bunch of different medications for the same type of thing. And it could be blood pressure medications that can be which is most common that I see is a lot of blood pressure medications and things like that. But there are multiple different things that people can be on. So treated for the same thing.
Medication safety risks in long-term care are examined on the impact of preventive health measures in elderly populations.
How do multiple medications increase the risk of falls?
Schenk:
Sure. Why would that be a potential risk then? Like why is being on multiple medications at times a problem?
Durek:
A lot of the time with medications being, treating for the same thing with multiple medications. A lot of them, a lot of seniors don’t know what they’re on, don’t know what they’re on it for. Don’t know how long they’re supposed to be taking it.
A lot of times prescribers now are just prescribing it and telling people you’re gonna be on it for the rest of your life. In reality, they don’t need to be on some of these medications for the rest of their life. And then also more than likely, one pill is treating the symptoms of another pill that they’re on caused by another pill that they’re on.
The consequences of inappropriate prescribing for older adults are analyzed on the impact of preventive health measures in elderly populations.
So they just get stacked on top of each other and on top of each other and on top of each other, which can easily overmedicate somebody, especially if the primary prescriber doesn’t know everything that that person is taking, which is very important as well. That includes everything that’s prescribed from multiple doctors.
’cause, everybody’s got a specialist somewhere. People take vitamins ’cause they’ve seen on tv it was a good idea. So it’s very good for the main prescriber to know literally everything that people are on, whether it’s over the counter vitamins or any kind of prescribed medication.
System-wide medication management failures are discussed on the impact of preventive health measures in elderly populations.
Which types of medications are most commonly linked to falls?
Schenk:
Is there any type of medication in your experience? It’s more linked to causing falls or exacerbating falls than other drugs?
Durek:
I have a large cardiac background, so I have seen multiple cardiac medications where people are on 4, 5, 6, different blood pressure, heart rate medications where in reality they really don’t need to be on that many.
But there are multiple different things. A lot of the times there’s antidepressants, anti anxieties, some types of antihistamines like allergy medications. Pain medications, muscle relaxers and those are a lot of the larger common ones. But in my experience, I’ve seen a lot with cardiac medications.
Age-related vulnerability to adverse drug events is explored on the impact of preventive health measures in elderly populations.
What are the warning signs that a senior may be overmedicated?
Schenk:
So other than the medication list being a scroll, what are some of the warning signs that a long-term care resident is being overmedicated?
Durek:
It’s really important to kinda know the baseline. So when I say baseline, it’s kinda knowing what the person is on an everyday basis before something new comes about.
New symptoms, new medications. Something like that comes about. A lot of the times you’ll see they might be getting a little bit more off balance. They might be more sleepy than other times. They might not be sleeping at all because insomnia is one of the side effects that’s happening to the over medication.
Drug interactions and pharmacologic risks in older populations are detailed on the impact of preventive health measures in elderly populations.
Mood swings, they’re usually a generally happy person and they are just running off the rails. Angry is I’ll be it really just depends. And sometimes it’s very subtle and sometimes it’s very. Top of the scale. It just, every person’s different and it just depends on each person as well.
But a lot of the times it’s the dizziness, the confusion, and the sleepiness that I’ve seen.
Medication mismanagement may form the basis of a claim, as explained on our page about drug errors in Georgia nursing homes.
How can healthcare providers help reduce fall risks from polypharmacy?
Schenk:
What are some of the things that we can do to potentially reduce the risk of falls from polypharmacy itself?
Durek:
I, so what my family did personally, we recently had put a loved one in a facility and over the last year or two, we have really drastically looked at their medications and got her down from 10 medications to five.
Because she really didn’t need to be on all of these different medications. She was on three or four two or three different blood pressure medications, but she was always dizzy, always off balance. We tried her off of a couple different ones and she got better. It’s always something that families can look at and see if they have any kind of medical background.
Serious harm can result from improper dosing, discussed further in medication error cases handled by Atlanta nursing home abuse lawyers.
They can look at all of their medications and see if they have any idea what they are and see if they know why they’re on those medications. How long have they been on them? Going to see your prescriber or whatever, you could talk to them about what they really need to be on, what they really need to be on for life, and what things you can get rid of and trial and error.
Which one would be the best one to take somebody off of, because a lot of these medications really aren’t forever.
Families are encouraged to remain vigilant by reviewing why you should always check nursing home ratings.
Schenk:
So somebody without a nursing background, like how do they do that? Does, do they just start, does Google your best friend, like you take the medication list and start Googling things?
Durek:
I have a stigma against Dr. Google. It can help, but it can also be a detriment. I would say if you do start Googling things and I dare say that with a fine tooth comb. If you do start Googling things just look at the pure basics. What is the medication, what is it for? And maybe look at a couple symptoms and just write that down on a piece of paper next to the name of the medication and hand it to your family or your, your loved one’s family doctor and being like, Hey, is there some stuff?
Staffing and safety concerns are highlighted in a proposed Georgia bill requiring better background checks for nursing homes.
I was looking at these meds. Is there some stuff that we can take off of here that they really don’t need? And that’s probably as far as into the Googling I would get ’cause we don’t know how muddy that can get. Your prescribers, they are busy, but they are, I think they just get so caught up in the day to day, but they actually feel refreshed when people actually ask them a question pertaining to something medical.
That’s been my experience actually. They’re there to help you. If not the doctors and the nurses that are working with you it’s always a good idea to run it by somebody. The worst they can tell you is no.
Local legal options are available through our Kennesaw nursing home abuse lawyer
Are there safer alternatives to high-risk medications for seniors?
Schenk:
So you described at least in some instances, a process of trial and error as you’re trying to cut the list of medications, trying to eliminate them.
What does that look like? Is it just a, is it like, hey, let’s, we’re gonna take our loved one off of this for three days or a day and see what happens? What is the trial and error process?
Durek:
It depends on the medication. Some medications can stop cold Turkey. And see how they do other medications, you have to get a different dose.
So trial and error basically looks different depending on the medication. You can go cold turkey off of some medications. Other medications, like a lot of the antidepressants, anti anxieties, anti-convulsants, opioids, you can’t do that. You might have to talk to your primary doctor, your prescriber and see if there is something like a lower dose that they could trial for a couple days.
Common causes of prescription mistakes are discussed in Episode 54: Medication Errors and Nursing Homes.
I know when I went off of medication recently, I had to wean it down. I was on a higher dose, so I weaned down to the next lower dose for a week and then I lowered down to the next dose after that lower. And then I went off the medication. So it just, you would have to really work closely with your prescriber depending on what the medication is to see if it’s something that you would have to wean off.
And what is the best way to do that. Sometimes when people wean off of antidepressants or anticonvulsants, they have to have another medication added in to help them wean off. So it’s just something that you really have to work with your prescriber about.
Systemic medication misuse is examined in Nursing Homes Improperly Medicate Residents – Episode 107.
Schenk:
Yeah, it sounds like it could potentially be a process of two steps forwards, one step back kind of thing. Yeah. I see.
Durek:
It can. But in the long run it might help out quite a bit.
Schenk:
So I guess how long, at least in, in your experience with your loved one, how long did it take you to get from 10 medications to, I think you said five. Was that like weeks, months, days, hours?
Durek:
It was a couple doctors, ’cause she had a couple different specialists.
So we took her off some vitamins, seeing how she was doing. And she started doing well. And then with her blood pressure medications, we trialed down a lower dose of, one of her beta blockers which helps with the heart rate. And her heart rate was staying stable, so we looked at.
Practical strategies for reducing errors are outlined in How to Minimize Medication Errors in Nursing Homes.
Her blood pressure, did she need to be on the two blood pressure medications that she was on? Because the beta blocker can help with the blood pressure, but it’s not necessarily specifically for it. So we were checking her blood pressure frequently and we would lower the dose down. So it took a couple months to get there, but after, I don’t know, three, four months, we got her off of the two blood pressure medications and she was just on the beta blocker.
And to this day in her facility, I think she is only on four prescribed medications in a multivitamin.
Medication errors often intersect with fall risk, as discussed in Episode 42: How Nursing Homes Can Be Liable for Injuries From Falls.
Schenk:
It sounds like a lot of love and work goes into that. You’re, it sounds to me like obviously if you’re in a facility, you’re always doing vitals, but it sounds like you’re being extra vigilant about vitals, extra vigilant on behavior changes and things like that while you’re going through that process.
Durek:
It can be yes. Definitely depending on what symptoms or side effects that your loved one’s having from these said medications. And it can be if they’re in a facility, if they’re still at home, that’s extra work on you or whomever. But if it’s something that is something that you and your family feel necessary, then it’s definitely something that’s doable.
It’s just a process of trying to figure out what. Puzzle pieces go where basically.
Preventive strategies are further explored in Five Ways to Prevent Falls in Nursing Homes – Episode 122.
Schenk:
Yeah, that’s a, that seems to be a reoccurring theme in this podcast is family involvement and that the more the family is involved, the more the family can help the caregivers and the better off everybody is, especially the residents. Very well said. Jay, thank you so much for coming on the show and sharing your knowledge with us today.
Durek:
Yeah, no problem. Thank you for the invite. It was a pleasure.
Schenk:
Folks, I hope you found this episode educational. If you did, please be sure to and subscribe. Man, I haven’t said that in a long time.
And subscribe wherever you get your podcast from. If you have an idea for somebody that you would like for me to talk to, let me know. If you have an idea for a topic that you would like for me to talk about, let me that as well. New episodes of the Nursing Home Abuse Podcast come out every single Monday.
And with that folks, we’ll see you next time.
Thanks for tuning in to the Nursing Home Abuse podcast. Nothing said on this podcast either by the host or the guest, should be construed as legal or medical advice, nor is intended to create an attorney-client relationship between the host or their guest and the listener. New episodes for now are available every other Monday on Spotify, apple Podcasts, or on your favorite podcast app, as well as on YouTube and our website, nursing home abuse podcast.com.
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