Falls have been the bane of our existence since the beginning of time. Falls result in significant injuries to our seniors both in community-based housing and post-acute care settings. A significant number of admissions to post-acute care are initiated due to injuries related to falls. Then the family wants you to prevent grandma from falling, easier said than done right?
So, the debacle continues in post-acute care. Somehow it is okay if grandma falls at home but not if she falls in our center. So, I read with interest, an article published in Caring for the Ages regarding CNS medications and it made me stop. Think about how many of our residents come to us from acute care after a catastrophic event. They have had pain medications, antibiotics, or psychoactive medications while in acute care. Now we admit them to our rehab center for therapy and they become depressed. What do we do? We add an anti-depressant medication, right? This study found that SSRIs (selective serotonin reuptake inhibitors) were associated with the highest increase in falls, almost twofold!
Imagine my surprise when Zoloft was identified as the most highly effective and the most commonly prescribed SSRI in 2017. Celexa, Lexapro, and Prozac are close behind, also SSRI medications have been shown to increase the risk of falls two-fold. Hmmm, first do no harm. Maybe it is time to talk to our physicians about their prescribing practices and be sure they are documenting their rationale for choosing a specific medication. It is also a great idea to engage your QAPI committee, pharmacy, and falls team to do a little digging and see if you identify a connection. What the heck, can’t hurt, and maybe, just maybe you will prevent that next fall! Stay well, stay informed, and stay tuned!