Senior Living
Articles
Fall Prevention Using Pharmacogenomics
June 16, 2024
Slips, trips, and falls are a significant concern in long-term and post-acute care, especially for individuals over the age of 65. According to the CDC, over one in four Americans aged 65 and up fall each year, making fall prevention a critical aspect of care for older adults. Facilities spend considerable time and resources developing fall prevention programs, but there’s always more to be done. One promising tool for reducing falls is pharmacogenomics (PGx), the study of how an individual’s genetic makeup affects their response to medications.
The Burden of Falls
Every second, an older adult falls, and every 20 minutes, an older adult dies from a fall in the United States. With increased life expectancy worldwide, the incidence and costs of falls are expected to grow significantly. In the U.S. alone, older adult falls cost approximately $50 billion annually, a figure projected to exceed $101 billion by 2030. Globally, falls are the second leading cause of unintentional injury deaths. Understanding the root causes and developing effective prevention strategies through care plans and policy development are crucial.
Risk Factors
Fall prevention programs typically address common risk factors, categorized as modifiable and non-modifiable. Modifiable risk factors include vision problems, foot and footwear issues, and home hazards, which can be addressed to reduce fall risk. Non-modifiable risk factors, such as age, sex, race, and pre-existing health issues, are harder to
control but are essential considerations in protecting residents.
PGx and Fall Risk
Medications that increase fall risk are a significant modifiable factor in fall prevention programs. Many older adults are prescribed medications with side effects like drowsiness, dizziness, impaired balance, blurred vision, confusion, and seizures, all of which can lead to falls. The risk of falls and fractures is often dose-dependent, highlighting the importance of proper medication management.
PGx testing can play a vital role in medication management by identifying drugs that increase fall risk and adjusting prescriptions accordingly. PGx testing assesses how an individual’s genetic profile affects their drug metabolism, enabling physicians and pharmacists to make informed decisions about medication use. For instance, they can stop medications, switch to safer alternatives, or adjust dosages based on genetic insights. A notable example is the use of selective serotonin reuptake inhibitors (SSRIs) like Zoloft, Celexa, Prozac, and Lexapro. These antidepressants can cause ataxia, impaired psychomotor function, and syncope, contributing to fall risk. Pharmacogenetic testing helps prescribers adjust doses or choose alternative medications to enhance patient safety.
Implementing Precision Medicine into a Falls Reduction Plan
Integrating PGx testing into a fall reduction plan is becoming increasingly feasible. Modern solutions allow physicians to review all prescriptions within a facility or home group, identifying medications that pose risks, including falls. Residents on high-risk drugs can undergo simple PGx testing, with results often integrated directly into electronic health records (EHRs) for ease of access.
Evidence-based, clinically backed PGx tests and software provide actionable results, helping facilities and providers incorporate precision medicine into their fall prevention programs. This approach supports various aspects of medication management, including:
• Medication selection: Avoiding ineffective or toxic medications and reducing polypharmacy
• Optimizing dosing: Preventing overdosing and underdosing
• Ensuring proper monitoring: Avoiding rapid up-titration and delayed target attainment
Falls in older adults impose significant emotional, economic, and resource burdens. However, they should not be viewed as an inevitable part of aging. Advances in fall prevention, particularly through medication management and tools like the American Geriatrics Society’s “Beers Criteria,” have made substantial progress. The emerging standard of care now includes recognizing drug-gene interactions through PGx, offering a powerful addition to fall prevention strategies