The objective of the proposed study is to reduce the incidence of falls and fall-related
injuries among community-dwelling older adults by better utilizing community pharmacists to
advise patients and physicians on medication management.
Falls are the leading cause of both fatal and nonfatal injuries among older adults in the
United States. Past research suggests that individuals taking four or more prescription
medications are at increased risk for falls. CNS-active drugs (e.g., benzodiazepines), in
particular, have been associated with increased risk. Research also suggests that
interventions to reduce inappropriate medications can reduce the risk of falls. This
finding comes primarily from multifaceted interventions, however, and the impact of
medication modification, by itself, remains largely unknown.
This study is using a a randomized controlled clinical trial design to evaluate a falls
prevention program targeting community-dwelling older adults through community pharmacies.
The study focuses on individuals at high risk for future falls. Individuals in the
intervention group receive an in-depth consultation concerning their current medications,
conducted by a community pharmacist. The consultation is designed to elicit
medication-related problems (e.g., orthostatic hypotension, daytime sedation). Problems
identified during the consultation, and therapeutic recommendations designed to address
these problems, are communicated to the prescribing physician. With physician approval,
appropriate modifications are made to the patient's medication regimen. The primary study
endpoints are: time to first fall and proportion of individuals who fall during the one-year
Two primary hypotheses will be tested.
1. Compared to individuals in the control group, individuals in the intervention group
will experience a 30% reduction in the hazard of falling (hazard ratio=0.70) for time
to first fall following randomization.
2. Compared to individuals in the control group, 25% fewer people in the intervention
group will experience a fall during the one-year follow-up period.
If the intervention is effective in reducing falls, these effects should be mediated by
improvements in the overall quality of medication use. Thus, we will also assess effects
of the intervention on: change in the number of inappropriate medications prescribed and
change in the number of CNS-active medications prescribed.
One secondary hypotheses will be tested.
1. Compared to individuals in the control group, individuals in the intervention group will
experience a 40% reduction in the use of high-risk medications during the one-year follow-up
- Currently taking at least four prescription medications
- Currently taking at least one high risk medication
- At least one fall during 12 month period before study entry
- Able to speak and read English
- Resident of a long-term care facility
- Cognitive impairment