Falls

Prevent falls; manage changes

Fall Changes, Falls, and Your Changes

Posted on by Michelle Fritsch, Pharm.D.
Prevent falls; manage changes
Physical changes can increase risk of falls.

In Maryland, the leaves are turning beautiful fall colors. The air is crisp more often, and that fuzzy blanket feels good at night! The move from summer to autumn makes itself known in obvious and in subtle ways.

Throughout life, your body makes changes, too. Some are obvious. Some are subtle.

Many of these changes increase your risk for falls and/or injury with a fall.

Obvious changes

  • Joints get stiffer
  • Lung capacity gradually decreases – you might get short of breath easier
  • Skin gets drier as overall body water content decreases
  • Vision changes, especially your ability to see up close
  • Skin and tissues get looser

Subtle changes

These changes are usually caught when your doctor monitors your labs, your urine, or does a physical exam.

  • Kidneys slow down
  • Liver slows down
  • Bones get less dense (hard)
  • Reflexes aren’t as quick
  • Risk for urinary track infection goes up
  • Hormone production changes – for men and women

Association with falls

As we move slower, have more joint pain, lose some of our range of motion, and reflexes slow, the risk of falls goes up. As senses such as vision, hearing, touch, smell, and even taste change, these also increase the risk of falls.

The kidney and liver changes are especially important as we think about the impact on how our body handles medications. The liver is the key organ that breaks down medicines in our body. The kidney is one of the primary ways they are then removed. So, as our kidneys and liver slow down, for many medicines, we need lower doses. Sometimes, at some point in the decline of kidneys or liver, some medications should NOT be used at all.

Falls can lead to losing your ability to walk, run, climb stairs, and be as active as you would like to be.

Remember, with accumulated years we also grow in wisdom, in maturity, and learn to count the blessings in our lives! Graceful aging is a beautiful thing. I just don’t want you to fall!

Call us at Meds MASH for a thorough assessment of your current changes, your medications, and ways to decrease your risk of falls. This is one of our specialties! Michelle is one of the creators of a comprehensive falls risk assessment.

You can reach Michelle at michelle@medsmash.com; 410-472-5078; www.medsmash.com/contact.

BIBLICATION APPLICATION

Our bodies aren’t the only things that change with time. Our Christian walk is also a journey with twists and turns. Ideally it is an uphill climb to more maturity. But without practice and several bumps in the road, it can be a very flat journey.

Ephesians 4:14-15 ESV

So that we may no longer be children, tossed to and fro by the waves and carried about by every wind of doctrine, by human cunning, by craftiness in deceitful schemes. Rather, speaking the truth in love, we are to grow up in every way into him who is the head, into Christ,

Growing, learning, and changing take effort and dedication. Practice makes perfect. I don’t expect any of us will reach perfect until Heaven, but practice can certainly help us with improvement.

Hebrews 5:12-13 ESV

For though by this time you ought to be teachers, you need someone to teach you again the basic principles of the oracles of God. You need milk, not solid food, for everyone who lives on milk is unskilled in the word of righteousness, since he is a child.

To grow and change, we take risks, learn from our mistakes, and gain confidence as God sees us through each obstacle.

James 1:1-27 ESV

James, a servant of God and of the Lord Jesus Christ, To the twelve tribes in the Dispersion: Greetings. Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing. If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him. …

Romans 5:3-4 ESV

More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope,

Rather than avoid the changes that include hardship, know that God will get you through them, and you will grow and change in beautiful ways with each piece of the journey.

Blessings,

Michelle

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board certified geriatric pharmacist

Why would you benefit from a board certified geriatric pharmacist?

Posted on by Michelle Fritsch, Pharm.D.
board certified geriatric pharmacist
How Meds MASH promoted safe, healthy, active living

I started a company that I call Meds MASH in 2015. I am a board certified geriatric pharmacist. That means I specialize in medication use in people over the age of 60.

What Meds MASH doesn’t do for you:

  • Fill your prescription
    • Your local pharmacist will do this
  • Change any of your prescription medications
    • I will make suggestions to your doctors or help you discuss them with your doctor
  • Take over your healthcare
    • You will keep your doctors who will lead your healthcare

What Meds MASH will do for you:

  • Talk with you to find out what are your health and life goals
  • Review all of your medications
    • Prescribed
    • Over-the-counter
    • Vitamins
    • Supplements
    • Herbal remedies
    • Any other substances
  • Obtain your medication history
  • Review your labs to check for medication safety
    • Kidney function
    • Liver function
    • Medical condition control
    • Side effects
  • Review your medicines compared with your allergies
  • Evaluate in-depth for risks of falling
  • Review for some common issues that are often missed
  • Make sure you understand each of your medications and how to best take them
  • Take time and answer your questions
  • Provide you with detailed information you can review later and share with your doctor
  • Talk direct with your doctors at your request and authorization
  • Engage your family at your request and authorization

Does Meds MASH make a difference? On average in an initial review- 

  • We make 4.5 interventions
  • A recommendation is made to improve two medications
  • A recommendation is made to change a medication for 82% of clients
  • Over 98% of the time a significant suggestion about medication is made!

Questions frequently asked

Doesn’t my doctor already do this?

  • Rarely does your doctor know absolutely every medication you take and how you actually take it.
    • Meds MASH specializes in obtaining this before reviewing the medications.
  • Only a small percentage of people over 60 have a doctor board certified in geriatrics.
    • Meds MASH provides a board certified geriatric expert.
  • Most people have 7-15 minutes with their doctor.
    • Most Meds MASH initial visits are 45 minutes.
  • Rarely are people fully prepared for their doctor visit.
    • Part of a Meds MASH review includes specific strategies to get the most out of each medical visit with your doctors.

Doesn’t my pharmacist already review all of my medications?

  • Rarely does your pharmacist know all of the medications you take.
    • They know the prescriptions only, even if you only use one pharmacy.
      • You absolutely should use only one pharmacy!
    • Your pharmacist has a limited time to carefully review your medicines.
    • There are not many geriatric board certified pharmacists in the country.

Contact us today for a free consultation! Meds MASH 410-472-5078 or e-mail michelle@medsmash.com or on the website www.medsmash.com/contact.

BIBLICAL APPLICATION

There is a lot of talk about and emphasis on being ‘transparent’ today in our society. It has taken me months to clearly, succinctly state what we do at Meds MASH. I am still honing the message so that it really makes sense to people. We need to be able to put things in someone’s own perspective to help them really understand.

If an alien from Mars came to visit and talked to you about places, customs, and politics on Mars, it is unlikely you would understand very much of it. You would have no perspective of how things look or operate on that planet.

I had this same thought this week as I was reading the Psalms, especially the ones written by David. David was the king. He was responsible for all of the people. His perspectives were oriented around keeping people safe and alive.

He frequently talks about enemies and God’s protection in wars. I’m sure they were attacked, or at risk of being attacked, most of the time. God made it clear that when the people of Israel went into battle with God’s protection, then they would prevail.

Deuteronomy 28:7 ESV

“The Lord will cause your enemies who rise against you to be defeated before you. They shall come out against you one way and flee before you seven ways.

When they went into battle on their own, the outcomes were not so good.

Numbers 14:39-45 ESV

Israel Defeated in Battle

When Moses told these words to all the people of Israel, the people mourned greatly.  And they rose early in the morning and went up to the heights of the hill country, saying, “Here we are. We will go up to the place that the Lord has promised, for we have sinned.”  But Moses said, “Why now are you transgressing the command of the Lord, when that will not succeed?  Do not go up, for the Lord is not among you, lest you be struck down before your enemies.  For there the Amalekites and the Canaanites are facing you, and you shall fall by the sword. Because you have turned back from following the Lord, the Lord will not be with you.”  But they presumed to go up to the heights of the hill country, although neither the ark of the covenant of the Lord nor Moses departed out of the camp.  Then the Amalekites and the Canaanites who lived in that hill country came down and defeated them and pursued them, even to Hormah.

Our personal battles aren’t with swords, but they are still battles. And if God is for us and leading us, then our outcomes are infinitely better than when we do battle on our own without Him.

David also makes frequently reference to rain, crops, vineyards, and grain. We don’t tend to spend our days focused on those things. Our grocery stores and markets are filled with all we need.

But what are the daily struggles in your life that mean just as much to you as ability to grow crops meant in David’s time? Is it your finances, your job, career opportunities, relationships, finding your meaning in life? Our daily struggles are no less important that David’s. Our world and our perspectives are just different.

So, whatever your battles, lay them before the Lord. Honestly lay it all out there. Be completely transparent and clear in your requests before God. He already knows. He loves the trust you place in Him as you bring it all to Him.

Psalm 71:14-17 ESV

But I will hope continually

    and will praise you yet more and more.

My mouth will tell of your righteous acts,

    of your deeds of salvation all the day,

    for their number is past my knowledge.

With the mighty deeds of the Lord God I will come;

    I will remind them of your righteousness, yours alone.

O God, from my youth you have taught me,

    and I still proclaim your wondrous deeds.

If you’re ever at a loss for what to pray, consider the Psalms. They are the prayers and songs of praise of David. Put it in today’s perspective, and you’ll find they are completely relevant to your needs today.

Blessings,

Michelle

Falls – Steps you can take now to prevent them

Posted on by Michelle Fritsch, Pharm.D.
fallenman
Be proactive to prevent falls that could change your future.

I have been talking with a lot of groups and individuals about ways to prevent falls. Falls come out of nowhere most of the time. You don’t even think about them until they happen.

According to data from the Centers for Disease Control, there are over 2.8 million older adults seen in the emergency department for falls every year! Yes, 2.8 million!!!   And these are not always the obvious people who can just look at and tell they could easily fall. Many would consider themselves health, active, and not at risk.

You CAN determine your risks and take action now to lower them.

So, how do you determine if you have this falls risk?

The Center for Disease Control tackled that question and developed the Stopping Elderly Accidents, Deaths, and Injuries. They created a toolkit with several resources. Some of the resources are for your doctor or other healthcare provider. Others are for YOU to help find and minimize your personal risks.

You can find access to these tools on our Meds MASH website. Or you can follow this link: https://www.cdc.gov/steadi/patient.html. You will find information about falls, how often they happen, and many of the risk factors. You will also find tools to help you assess yourself and your home.

I especially encourage you to complete the Check for Safety checklist. It has you walk room to room through your house looking for specific risk factors. It also has several tips to help you avoid falls.

Next, I encourage you to complete the Stay Independent checklist. This will ask you a series of 12 questions. You will answer each with a ‘Yes’ or a ‘No’. Then, take this list with you to your next doctor’s appointment. This will help you to have a very focused talk with your doctor about ways to minimize your falls risk.

Finally, read the What You Can Do to Prevent Falls brochure. This will give you even more tips to help you avoid a fall.

What can you do to lower your falls risk?

There are four different assessments in the toolkit that your doctor can use to better understand how to help you decrease your risks. One of these you can do yourself.

It is called a Chair Rise Exercise. It can help you gain strength in your thighs and buttocks. This will help you be more stable when you walk. Here are the instructions from the CDC STEADI guide:

How to do it: 

  1. Sit toward the front of a sturdy chair with your knees bent & feet flat on the floor, shoulder-width apart.
  2. Rest your hands lightly on the seat on either side of you, keeping your back & neck straight & chest slightly forward.
  3. Breathe in slowly. Lean forward & feel your weight on the front of your feet.
  4. Breathe out & slowly stand up, using your hands as little as possible.
  5. Pause for a full breath in & out.
  6. Breathe in as you slowly sit down. Do not let yourself collapse back down into the chair. Rather, control your lowering as much as possible.
  7. Breathe out.

What about medications?

There are so many medications that can increase your risk for falls. That’s one of our specialties at Meds MASH. We can take a thorough look at all of your prescribed medicines, your over-the-counter medicines, your vitamins, your herbal medicines, and any other substances. Even the doses you take, your kidney function, and your liver function will be assessed. We will also look at the timing of your medicines and your diet. All of these things work together to impact your falls risk.

For more information contact us at www.medsmash.com and 410-472-5078.

BIBLICAL APPLICATION

One of the best ways to avoid falls is to know your risks and take steps to minimize them. You need to do some work, and usually get some professional input, to fully analyze those risks. Then, it takes personal motivation to do the exercises, change the shoes, use the assistive device, or work with your healthcare team to make the medication changes to lower your risks.

What are your risks to fall off the path of Christ? I’m thinking of the parable of the seeds found in Matthew 13.

Matthew 13:8 NLT

Still other seeds fell on fertile soil, and they produced a crop that was thirty, sixty, and even a hundred times as much as had been planted!

How do we avoid the thorns, the rocks, the birds, the hot sun, and the shallow soil that kept the other seeds from growing?

Jesus explains the parable later in the chapter.

Matthew 13:23 NLT

The seed that fell on good soil represents those who truly hear and understand God’s word and produce a harvest of thirty, sixty, or even a hundred times as much as had been planted!

God’s Word and the value of our studying, understanding, and applying it are found throughout the Bible. It is throughout the Hebrew Bible, Proverbs, Psalms, and throughout the New Testament.

2 Timothy 3:16 ESV

All Scripture is breathed out by God and profitable for teaching, for reproof, for correction, and for training in righteousness,

Proverbs 4:20-22 ESV

My son, be attentive to my words; incline your ear to my sayings. Let them not escape from your sight; keep them within your heart. For they are life to those who find them, and healing to all their flesh.

Isaiah 40:8 ESV

The grass withers, the flower fades, but the word of our God will stand forever.

Psalm 119:105 ESV

Your word is a lamp to my feet and a light to my path.

John 14:21 MSG

“The person who knows my commandments and keeps them, that’s who loves me. And the person who loves me will be loved by my Father, and I will love him and make myself plain to him.”

What is your grasp of the Word of God? If that is the key to ‘letting our seed grow’, what is your growing potential? I know I have rocks and thorns and birds that try to snatch my seeds away in my life.

It takes motivation and discipline to stay in God’s Word on a regular basis. It takes discussion and study with others to really understand it from varying perspectives. And, it takes talking about it with other people to apply it.

People, instructors, pastors, mature Christians can help you gain the self-insight needed to really determine where your stumbling blocks are. Sharing and accountability help us stay focused and commit to the spiritual exercise, assistive devices, and work required to maintain ‘fertile soil.’

Psalm 1:1-3 ESV

Blessed is the man

    who walks not in the counsel of the wicked,

nor stands in the way of sinners,

    nor sits in the seat of scoffers; 

but his delight is in the law of the Lord,

    and on his law he meditates day and night.

He is like a tree

    planted by streams of water

that yields its fruit in its season,

    and its leaf does not wither.

In all that he does, he prospers.

Blessings,

Michelle

Image source: National Library of Medicine, National Institutes of Health, United States Department of Health and Human Services

Preventing Falls – New Tools and Resources

Posted on by Michelle Fritsch, Pharm.D.
fallenman
There are new tools to help you avoid falls.

Now that it is fall, let’s talk about falls. September 22 (or the first official day of fall each year) is national Falls Prevention Awareness Day. This year we have some new resources to learn about and to celebrate.

Every year very unintended falls, those slips that come out of nowhere, lead to deaths, fractures, hospitalizations, and need for assistive devices. In addition, fear of another fall leads to changes in day-to-day activities. One ‘little oops’ can take someone from doing all they want to do to needing assistance and having restrictions. No one wants that.

Falls Risk Factors

Besides snow, ice, and rickety steps there are so many things that can increase your risk for falling. Below are a few.

Medications

  • Those that make you sleepy
  • Those that relax you or change your mood
  • Those that make your blood pressure drop too low or too suddenly
  • Those that make your blood sugar dip too low
  • Many pain medicines
  • Any medicine that makes your mouth and eyes really dry
  • Most of the over-the-counter sleep aids

Medical conditions

  • Heart disease
  • Stroke
  • Anything that makes your legs hurt
  • Pain in general
  • Obesity
  • Incontinence

In your home

  • Rugs
  • Cords
  • Pets that get under your feet
  • Steps

Other

  • Vision problems or glasses that don’t fit or aren’t the right prescription
  • Hearing problems
  • Using a cane, crutches, or walker in the wrong way

Wow, and this is just a partial list!

New Falls Prevention Resources

That is why I am so excited to tell you about some new resources from the Centers for Disease Control (CDC). They released last summer the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit. The toolkit can be found here: http://www.cdc.gov/steadi/patient.html. You can find a checklist for your home. This will help you identify and fix any risks you might not have known about. There is a checklist to complete before you go to the doctor. It will help your doctor determine how much fall risk you have. The specific resources in the toolkit I encourage you to pull up are:

  • Stay Independent questionnaire
  • What Can You do to Prevent Falls brochure
  • Check for Safety home assessment guide

The STEADI toolkit has now been joined by a new toolkit that focuses more on the role of medications, medical conditions, and your physical function. This toolkit is the result of a collaboration between the American Society of Consultant Pharmacists and the National Council on Aging. This ASCP/NCOA resource was announced on National Falls Prevention Day. It will be first unveiled in a webinar for pharmacists on October 18. You can learn more at the ASCP website.

Also, on the 2016 National Falls Prevention Day, the CDC has released new statistics about the realities of falls in the US. You can learn more here.

Let us provide a comprehensive assessment of your falls risks today! Your preventative steps today can keep you active in the future. You can contact us at www.medsmash.com/contact.

BIBLICAL APPLICATION

Falling, especially after age 50 can change the course of the rest of your life. No wonder so much effort is put into preventing these falls.

What about falling away from what we’re called to do as Christians? Have you ever done something so terrible you feel like life will never be the same? Have you gotten caught up in activities that you later realize are not what God would want you to do? How far away did you fall?

How did you feel when you realized you had fallen away?

It’s often a big life event that reminds us that we fell away from God. Sometimes it’s an illness or birth of a child or death of a loved one. Sometimes it’s loss of a job or the end of a marriage.

How do you know if you have fallen too far? Could you fall so far that there is no return to God?

Ephesians 2:1-6 MSG

It wasn’t so long ago that you were mired in that old stagnant life of sin. You let the world, which doesn’t know the first thing about living, tell you how to live. You filled your lungs with polluted unbelief, and then exhaled disobedience. We all did it, all of us doing what we felt like doing, when we felt like doing it, all of us in the same boat. It’s a wonder God didn’t lose his temper and do away with the whole lot of us. Instead, immense in mercy and with an incredible love, he embraced us. He took our sin-dead lives and made us alive in Christ. He did all this on his own, with no help from us! Then he picked us up and set us down in highest heaven in company with Jesus, our Messiah.

Amazing news! You are saved through amazing grace! There is absolutely nothing you can do that can separate you from God.

2 Corinthians 5:17 ESV

Therefore, if anyone is in Christ, he is a new creation. The old has passed away; behold, the new has come.

Ephesians 2:8-9 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast.

Romans 8:38-39 ESV

For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, 39 nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord.

So, you can fall and hurt your body in a way that can’t always be fixed. But, if you decide to come back, you CAN NOT fall so far away from God that you can’t return. We are so blessed! God is so good!

Blessings,

Michelle

Image source: National Library of Medicine, National Institutes of Health, United States Department of Health and Human Services

Medications and Falls

Posted on by Michelle Fritsch, Pharm.D.

Did you know that taking some medications can increase your risk of falling?

Did you know not taking some medications can increase your risk of falling?

Did you know some medical conditions can increase your risk of falling?

Did you know not getting enough of some vitamins can increase your risk of falling?

Wow, fall risks are so complicated!

The Centers for Disease Control recently created and released a tool for healthcare providers and patients to help screen for and diminish fall risk. You can find it at http://www.cdc.gov/steadi/patient.html. I encourage you to use these tools to minimize your risks.

Some of the things addressed are clutter in your home that can trip you, the importance of exercise to stay strong, use/add grab bars, sturdy hand rails, wear shoes or nonslip slippers, improve lighting, and more.

In addition, have a medication expert review all of your medications to minimize the fall risk caused by drugs that you take.   This is an area where all of your healthcare team can work together to make sure your risks are minimized.

Some types of medication are more likely than others to make falls occur more easily. Then, if you take several of these medicines, your risk is even higher.

The vitamin associated with falls is vitamin D. If you have too little vitamin D your risk is higher. If your doctor has not checked your vitamin D level, request that be done at your next visit. Most adults have a deficiency.

If you would like a thorough fall risk assessment, please contact Meds MASH at www.medsmash.com.

Biblical Application

I have been struck lately by the words to a song sung by Jason Gray, “More Like Falling in Love”. If you have not heard it, I highly encourage you to check it out.

The lyrics say,

“More like falling in love

than something to believe in

more like losing myself

than pledging my allegiance.”

“It’s like I’m falling in love.”

I adore this description of meeting and giving it all to Christ.

If you’re going to fall, what’s better than falling in love? And what’s better than falling deeply in love with Christ?

Luke 10:27 ESV

And he answered, “You shall love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind, and your neighbor as yourself.”

1 John 4:18 ESV

There is no fear in love, but perfect love casts out fear. For fear has to do with punishment, and whoever fears has not been perfected in love.

Psalm 85:10 ESV

Steadfast love and faithfulness meet; righteousness and peace kiss each other.

May you be enveloped with this wonderful love!

Blessings,

Michelle

Center of Gravity – Preventing Falls

Posted on by Michelle Fritsch, Pharm.D.

ps_weebles_playPicture a supermodel in her heels walking heel to toe. Now try it. Do you feel unsteady? When your feet are that close together, or even nearly crossing, it is easy to fall. Your center of gravity is very high. The bulk of the weight is up high with a narrow base. Now think of a Weeble – remember those toys with the rounded bottom wider than the top? They have a very low center of gravity (most of the weight in the bottom). They can tip over on their side and still return to standing.

If you’re ever feeling unsteady when walking, think about your center of gravity. Stand and walk with your feet farther apart. Take shorter steps. Lift your feet to avoid catching on grass, rocks, and other low obstacles.

When someone has fallen or is afraid of falling, you can notice these changes. As we become fearful we widen our stance, bend a little, and shuffle.

  • Arthritis in hips, knees, ankles, and feet can increase falls risk.
  • Dizziness, inner ear problems, or medications that make us dizzy can increase risk of falls.
  • Lack of sleep, getting up at night without light, and medications that make us sleepy can increase risk of falls.
  • Not drinking enough, especially during these hot summer months, can lead to dehydration making us dizzy.
  • Medicines that lower blood pressure can make us feel dizzy when we first stand up or turn.
  • Pets under our feet can be a source of tripping. So can throw rugs.

See the home falls prevention checklist under Resources at www.medsmash.com.

Biblical Application

The location of our faith has similar implications. When all of our knowledge of God is in our head, our center of gravity is high. When our center of gravity is high, it is easy to fall. Small things can whip and blow us about. Do you ever feel battered and blown from all directions?

  • work
  • relationships
  • finances
  • too busy
  • not feeling good

But with prayer, reading the Word, study, focus, faith enters our heart. And then it’s in our gut and our whole being.

As our faith gets deeper and deeper, our center of gravity deepens and we can handle heavy blows from any direction. The bad things still happen, but we can maintain our upright faith and dependence on God.

Then Christ will make his home in your hearts as you trust in him. Your roots will grow down into God’s love and keep you strong. Ephesians 3:17 New Living Translation

Let your roots grow down into him, and let your lives be built on him. Then your faith will grow strong in the truth you were taught, and you will overflow with thankfulness. Colossians 2:7 New Living Translation

May you grow deep roots!

Blessings,

Michelle