Outcomes of Fall-Focused Intervention Program
Outcomes of Fall-Focused Intervention Program
The effects of a fall-focused pharmaceutical intervention program (FFPIP) on the clinical and economic outcomes of elderly patients who fall while residing in a rehabilitation center are described.
The objectives of this retrospective observational study were to identify the differences in the number of patient falls among elderly patients before and after pharmaceutical interventions, identify the cost savings related to decreasing the number of falls, and determine whether a relationship exists between falls among the elderly and specific medication classes. A data collection tool was developed by the investigators to record demographics and medication use. Two hundred patients were randomly selected from the preintervention (October 1, 1999 September 30, 2000) and postintervention (October 1, 2000-September 30, 2001) periods. Two data collectors collected data from patient medical records to test the data collection tool and ensure accuracy.
The number of patient falls was reduced in the postintervention group by 47%, resulting in a future savings of $7.74 per patient per day. The use of several classes of medication also decreased in the postintervention period: cardiovascular agents, 10.7%; analgesics, 6.3%; psychoactive drugs, 18.2%; and sedatives and hypnotics, 13.9%. Patients most likely to fall were male, greater than 76 years of age, had a cardiovascular- or orthopedic-related diagnosis, and were taking analgesics, cardiovascular agents, and central nervous system agents, yet the intervention had a more significant effect on female patients.
Implementation of an FFPIP decreased falls by 47% and decreased the use of cardiovascular drugs, analgesics, psychoactive medications, and sedatives and hypnotics.
Falls are a common problem in the elderly population. Each year, among persons age 65 years and over, approximately 50% fall at least once and about 8% have an associated injury that requires acute medical attention. The elderly who fall have a median length of hospital stay of 6 days (mean, 10.4 days; range, 1-129 days), and 35% of patients stay in the hospital for more than 10 days.
The frequency of falls is even higher in nursing homes. Patients who reside in nursing homes presenting to the emergency department after a fall had high injury rates, high admission rates, and often-prolonged hospitalizations. Falling is not a diagnosis but may be a symptom of multiple underlying diseases, effects of certain medications, or environmental hazards, or obstacles that interfere with safe mobility. Both medication use and falls increase with advancing age. The frailest patients (those likeliest to fall) are often receiving the greatest number of medications, and improving their drug regimen is probably one of the most effective means of reducing fall risk.
The economic impact of unintentional injury from a fall is of increasing concern to public health practitioners and planners. There is strong evidence that falls are associated with increased health care costs and are the costliest injury among the elderly. A 1998 study suggests that one or more injurious falls was associated with increases in annual hospital costs ($11,042), nursing home costs ($5,325), and total health care costs ($19,440). In addition, the elderly may feel a loss of dignity and independence after a fall.
There is a paucity of intervention studies on the relationship between medication use and falls, although appropriate medication use is given a high priority in prevention of falls in the elderly. Elderly patients who have had two or more falls use a significantly higher number of sedatives and hypnotics, analgesics, and cardiovascular agents than those who have not fallen or fell once. Polypharmacy (five or more different drugs prescribed concurrently) is also associated with falls. An aggressive approach to fall reduction may include eliminating balance-altering medication. Prevention strategies should target the ordering and monitoring stages of pharmaceutical care. Drug regimen reviews in the long-term-care environment, which have been required for many years, designate specific criteria for the consultant pharmacist to monitor.
Programs designed to decrease medication use should be evaluated for their impact on the number and costs of falls. Morton Plant Mease (MPM) Health Care has found that falls result in significant health care costs (approximately $22,000 per fall) and that supporting the development of intervention programs that help to reduce patient falls and costs is paramount. Efforts to prevent falls in the elderly involve education, strengthening exercises, environmental improvements, and medication evaluation.
A pharmaceutical intervention program was implemented in the MPM Rehabilitation Center after reviewing the literature on falls and the elderly and analyzing the number of falls recorded by MPM Health Care and the associated costs. This retrospective study identified the economic and clinical impact on patients who fell during a one-year period before the fall-focused pharmaceutical intervention plan (FFPIP) compared with those who fell during a one-year period after an FFPIP was implemented. During the FFPIP the consultant pharmacist made recommendations about monitoring and altering patients' drug therapy to assist in the reduction of falls among the elderly. This study was conducted from patient and payer perspectives.
The effects of a fall-focused pharmaceutical intervention program (FFPIP) on the clinical and economic outcomes of elderly patients who fall while residing in a rehabilitation center are described.
The objectives of this retrospective observational study were to identify the differences in the number of patient falls among elderly patients before and after pharmaceutical interventions, identify the cost savings related to decreasing the number of falls, and determine whether a relationship exists between falls among the elderly and specific medication classes. A data collection tool was developed by the investigators to record demographics and medication use. Two hundred patients were randomly selected from the preintervention (October 1, 1999 September 30, 2000) and postintervention (October 1, 2000-September 30, 2001) periods. Two data collectors collected data from patient medical records to test the data collection tool and ensure accuracy.
The number of patient falls was reduced in the postintervention group by 47%, resulting in a future savings of $7.74 per patient per day. The use of several classes of medication also decreased in the postintervention period: cardiovascular agents, 10.7%; analgesics, 6.3%; psychoactive drugs, 18.2%; and sedatives and hypnotics, 13.9%. Patients most likely to fall were male, greater than 76 years of age, had a cardiovascular- or orthopedic-related diagnosis, and were taking analgesics, cardiovascular agents, and central nervous system agents, yet the intervention had a more significant effect on female patients.
Implementation of an FFPIP decreased falls by 47% and decreased the use of cardiovascular drugs, analgesics, psychoactive medications, and sedatives and hypnotics.
Falls are a common problem in the elderly population. Each year, among persons age 65 years and over, approximately 50% fall at least once and about 8% have an associated injury that requires acute medical attention. The elderly who fall have a median length of hospital stay of 6 days (mean, 10.4 days; range, 1-129 days), and 35% of patients stay in the hospital for more than 10 days.
The frequency of falls is even higher in nursing homes. Patients who reside in nursing homes presenting to the emergency department after a fall had high injury rates, high admission rates, and often-prolonged hospitalizations. Falling is not a diagnosis but may be a symptom of multiple underlying diseases, effects of certain medications, or environmental hazards, or obstacles that interfere with safe mobility. Both medication use and falls increase with advancing age. The frailest patients (those likeliest to fall) are often receiving the greatest number of medications, and improving their drug regimen is probably one of the most effective means of reducing fall risk.
The economic impact of unintentional injury from a fall is of increasing concern to public health practitioners and planners. There is strong evidence that falls are associated with increased health care costs and are the costliest injury among the elderly. A 1998 study suggests that one or more injurious falls was associated with increases in annual hospital costs ($11,042), nursing home costs ($5,325), and total health care costs ($19,440). In addition, the elderly may feel a loss of dignity and independence after a fall.
There is a paucity of intervention studies on the relationship between medication use and falls, although appropriate medication use is given a high priority in prevention of falls in the elderly. Elderly patients who have had two or more falls use a significantly higher number of sedatives and hypnotics, analgesics, and cardiovascular agents than those who have not fallen or fell once. Polypharmacy (five or more different drugs prescribed concurrently) is also associated with falls. An aggressive approach to fall reduction may include eliminating balance-altering medication. Prevention strategies should target the ordering and monitoring stages of pharmaceutical care. Drug regimen reviews in the long-term-care environment, which have been required for many years, designate specific criteria for the consultant pharmacist to monitor.
Programs designed to decrease medication use should be evaluated for their impact on the number and costs of falls. Morton Plant Mease (MPM) Health Care has found that falls result in significant health care costs (approximately $22,000 per fall) and that supporting the development of intervention programs that help to reduce patient falls and costs is paramount. Efforts to prevent falls in the elderly involve education, strengthening exercises, environmental improvements, and medication evaluation.
A pharmaceutical intervention program was implemented in the MPM Rehabilitation Center after reviewing the literature on falls and the elderly and analyzing the number of falls recorded by MPM Health Care and the associated costs. This retrospective study identified the economic and clinical impact on patients who fell during a one-year period before the fall-focused pharmaceutical intervention plan (FFPIP) compared with those who fell during a one-year period after an FFPIP was implemented. During the FFPIP the consultant pharmacist made recommendations about monitoring and altering patients' drug therapy to assist in the reduction of falls among the elderly. This study was conducted from patient and payer perspectives.
