Medications & Medical Management

Why this is important

Even common medications can increase the risks for falls in adults 65 and older. To help prevent patient falls in the outpatient radiation treatment clinic, we use CDC STEADI tools with AGS Beers Criteria.

SAFE Stops

S- Screen medication list (prescriptions, over-the-counter medication, and herbals) for fall-risk drugs (FRIDs).

• Assess vital signs, TUG, orthostatic blood pressure, fall history, and comorbidities.

F- Formulate a plan, share this plan with the patient’s care team (physician, MAs, nurses, and radiation therapists)

E- Educate patient and caregiver, document in electronic health record (EHR) including patient’s preferred language and teach-back.

FRIDs (some examples)

Benzodiazepines & Z hypnotics; antidepressants, antipsychotics; anticonvulsants; opioids; muscle relaxants; antihypertensives; diuretics; anticholinergics/antihistamines (e.g., diphenhydramine). Use Beers 2023 to verify risks and safer options.

Orthostatic hypotension: test and manage

Measure supine after 5 minutes, then at 1 and 3 minutes standing. Positive = drop of 20 mmHg systolic or 10 mmHg diastolic; or symptoms (lightheaded, faint).

Oncology workups

Before you start anything that might make the patient sleepy or be sure to arrange for an escort and reinforce fall precautions. Days 1-3 of RT: Fatigue often worsens. Check medications and symptoms again. If there is nausea or diarrhea, the patient may become dehydrated,

When to escalate

• The patient reports a recent fall

• Dizziness reported by patient or confusion observed by caregiver

• TUG scores of 12 seconds or more and the presence of orthostatic hypotension

Patient/caregiver teach-back (script)
“Some medicines can make you dizzy, sleepy, or unsteady. In your own words, which of your medicines could raise your fall risk, and what will you do if you feel woozy (sit down, hydrate if allowed, and call us)?” (Document preferred language and the patient’s response.) (CDC, 2024).