Who is at risk? 

NICE NG249 covers people aged 50 to 64 with conditions that increase falls risk, such as Parkinson’s disease, dementia, stroke, frailty or learning disability. In people over 65, risk may also be higher with diabetes, visual impairment, arthritis, neuropathy and osteoporosis.

You may notice early warning signs during ordinary contact in the pharmacy. These can include:

• Difficulty standing from a chair
• Shuffling gait
• Slowed walking
• Using furniture for support
• Visible frailty
• Poor footwear
• Bruising that may suggest a previous fall
• Confusion or reduced confidence when moving around.

Changes in behaviour can also be important. A person may mention that they are going out less, avoiding stairs, feeling unsteady, worrying about falling or relying more on carers or family members.

Brief observations and conversations can reveal concerns that may otherwise be missed. NICE NG249 also places greater emphasis on the psychological effects of falling, including fear of falling and reduced activity.

When appropriate, pharmacy technicians can ask simple screening questions and pass the answers to the pharmacist.

Useful questions include: “Have you fallen in the last year?”, “Do you feel unsteady when walking?”, “Have you had any near falls?”, “Do you ever feel dizzy when standing up?” and “Are you worried about falling?”

Two or more falls in a year, fall-related injury, inability to get up after a fall, blackouts, syncope or increasing frailty should be escalated for fuller assessment.

Contributing factors

Falls often have more than one cause. Intrinsic factors include health conditions, frailty, impaired gait or balance, cognitive impairment, poor vision, dizziness and continence problems, while extrinsic factors may include hazards in the home environment or unsuitable footwear.

Existing pharmacy services can be used to identify possible risk. Falls-related questions can be included in New Medicine Service, Discharge Medicines Service and vaccination consultations, as well as during repeat dispensing conversations and blood pressure checks. Referral triggers include:

• Frequent hospital admissions
• Patient or carer concerns
• Adherence problems
• Requests for compliance aids or alternative formulations
• Returned medicines
• Recent medicine changes
• Polypharmacy cases.

Blood pressure checks provide a practical opportunity to ask about postural symptoms. Dizziness on standing, feeling faint, blurred vision or weakness after getting up should be recorded and escalated.

Medicines that increase falls risk

Falls risk increasing drugs (FRIDs) are a key modifiable factor. Pharmacy technicians obviously cannot change treatment independently, but they can identify medicines that may need pharmacist review.

Medicines commonly associated with falls include benzodiazepines, Z-drugs, opioids, antidepressants, antipsychotics, anticholinergics, diuretics, antihypertensives and medicines that can cause hypoglycaemia (see Table 1).

Table 1: Falls risk-increasing drugs (FRIDs)