2026 Eastern States Conference

Title:
Reducing falls among Veterans in Home-Based Primary Care (HBPC) on antidepressants and/or benzodiazepines: a pharmacist-led intervention
Authors:
Kylie Thompson, Pharm.D.; Meghan Hamm, Pharm.D., BCPS; Lauren A. Stutzman, Pharm.D. BCGP
Objective:
The primary objective is to determine if mailed patient education reduces subsequent falls among HBPC Veterans prescribed antidepressants and/or benzodiazepines. The secondary objective is to determine if deprescribing antidepressants and benzodiazepines reduce the risk of falls among HBPC Veterans. Audience members will be able to outline the development and implementation process of pharmacist-led interventions designed to reduce falls within this targeted population.
Background:
Falls are a leading cause of injury and mortality in older adults. This project aims to reduce falls in HBPC Veterans through deprescribing and patient education, leveraging pharmacists' efforts to prevent medication-related falls.
Methods:
This is a single-centered prospective quality improvement project. Veterans were included if they were enrolled in the HBPC program at the Coatesville Veterans Affairs Medical Center, experienced a fall between January 1st, 2025, and April 1st, 2025, and had an active prescription for either an antidepressant and/or benzodiazepine. Veterans in hospice care or deceased prior to intervention were excluded. Chart reviews were completed; each review assessed the patient's current medication regimen, medical history, recent clinical assessments, and potential risks versus benefits of continued therapy. Antidepressant deprescribing recommendations were based on most current PHQ scores and duration of clinical stability. Prescribers were contacted if Veterans prescribed benzodiazepines/antidepressants qualified for deprescribing measures.  Additionally, all Veterans taking these medications were sent a patient education handout via mail highlighting the associated fall risks and providing strategies to mitigate these risks. Falls were assessed 90 days after implementing the patient education handout intervention.
Results:
During the review period, 30 patients who experienced a fall were prescribed an antidepressant and/or benzodiazepine. All patients that were taking a benzodiazepine were also taking an antidepressant. After applying exclusion criteria, 17 patients were included in the final analysis; 8 were eligible for antidepressant tapering and 3 were eligible for benzodiazepine tapering. Of 8 patients eligible for antidepressant tapering, 4 patients agreed. After recommendations sent to providers, 2 were accepted but 1 patient reconsidered, leaving 1 patient who successfully completed taper prior to end of review period. Of 3 patients eligible for BZD tapering, 1 patient agreed and recommendation was accepted by provider however the patient later reconsidered during follow-up therefore no patients were tapered off benzodiazepines prior to the end of the review period. 12 patients did not have a subsequent fall 90 days after patient education handouts were mailed, while 5 patients did experience another fall.
Conclusion:
After patient education handouts were sent by mail, the incidence of subsequent falls among HBPC Veterans who were prescribed antidepressants and/or benzodiazepines were reduced. Additionally, half of the tapering recommendations to providers were accepted. For recommendations that were declined, providers shared clinical reasons for why tapering was not appropriate at the time. Pharmacist-led interventions demonstrated value in efforts of deprescribing high-risk meds and reducing falls. Increased pharmacist-patient discussions about medication risks were well-received by Veterans and can support future deprescribing efforts. Providing tailored education on fall risks and reinforcing this information throughout care may improve outcomes. Enhanced collaboration between pharmacists and providers, as well as obtaining consistent depression assessments are valuable for ensuring patient-centered recommendations.
Self-Assessment Question:
What role can pharmacists have to reduce fall risk in the HBPC population?