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January 2009 Issue

Arvind Modawal, MD, (left) associate professor of family medicine and geriatrics, and medical student Robert Altenau conduct a single-leg stance test on Charles Orr. Modawal is working to prevent falls in older adults.
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Pharmacy, Medicine Team Up on Falls Study

By Angela Koenig & Katie Pence
Published January 2009

A hard tumble to the ground is enough to cause serious injuries for anyone, but for the elderly, a simple spill can prove disastrous—a grave injury or even death.

In fact, falls are the leading cause of injury and death among older adults, according to the Centers for Disease Control and Prevention, and account for 20 percent of injury and deaths for those 65 and older who reside in nursing homes.

A preliminary and collaborative research study between the UC College of Medicine and the James L. Winkle College of Pharmacy might give the elderly, their families, caregivers and physicians some insight into why some of these falls occur.

Researchers in the College of Pharmacy and the College of Medicine’s office of geriatrics looked at the medical records of 268 nursing home residents who were fallers and non-fallers, using residents of three nursing homes in the Cincinnati area.

Subjects were matched by age and gender in a case-control study design. The study’s conclusion was that subjects with an increased anticholinergic load had the most falls.

Anticholinergic properties are found in many common medications such as allergy medications, antidiarrheal agents, pain medications, antidepressants, anticonvulsants and incontinence medications and have been associated with many symptoms, including falls in the elderly.

“Falls are a very big issue for the elderly, especially in nursing homes, which have to document each and every fall but don’t always know the cause,” says Robert Cluxton, PhD, professor of pharmacy and coinvestigator.

Other coinvestigators on the study were Jodi Hoffman, a third-year PharmD student, Arvind Modawal, MD, associate professor of family medicine, and Becky Huang, second-year medical student and a geriatrics student scholar.

Medications, Cluxton says, are one of many variables that may contribute to falls. There is also vision, cognitive function, muscle condition and the environment.

What was most surprising about the research, he says, is that subjects who took anticonvulsants, which can have lower anticholinergic properties, had more falls, perhaps due to medication side effects which include gait disturbances.

“There are a number of not only medication-induced side effects but also environmental factors that can throw off a person’s balance with other aging and co-morbid conditions, so it can be complex,” says Modawal, who has an academic interest in falls and balance disorders in the elderly and who conceptualized and helped develop the study.

He continues, “Not all falls can be prevented, but the knowledge that medications may contribute to falls advances our knowledge in selecting medications with a low anticholinergic profile and other central nervous system side effects in treating patients to prevent falls.”

“Working with students and faculty in the James L. Winkle College of Pharmacy on this project will help to enhance future research and can greatly impact fall prevention efforts,” says Hoffman.

“It is great to have physicians and pharmacists working together to improve patient care and quality of life,” she says.

The study was recently presented at the joint annual meeting of the Ohio Medical Directors Association, Ohio Geriatrics Society and Ohio Society of Consultant Pharmacists in Columbus and also at the North American Primary Care Research Group in Puerto Rico.

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