Of the 20 medications that are most frequently prescribed to older adults, over half may increase fall injury risk, say researchers from the Karolinska Institutet in Stockholm, Sweden.
One-third of Americans over 65 take a tumble each year, and falling represents the largest source of fatal and nonfatal injury among older adults. Preventing falls in this population remains a top priority for health care providers and caregivers alike.
Jette Moller, study author and lecturer with the Department of Public Health Sciences at Karolinska, points out that a person's age, sex and health condition(s) can all compound fall risk, though these factors are largely uncontrollable. On the other hand, proper medication management could be a simple way to improve an older adult's chances of staying safely on their feet.
Polypharmacy—taking too many medications—is a common problem for older adults. Over 76 percent of Americans age 60 and older take two or more prescription drugs on a regular basis, according to the Centers for Disease Control and Prevention (CDC), and thirty-seven percent take five or more.
"Polypharmacy been suggested to increase the risk for fall in several ways; increased risk for inappropriate medications (i.e. fall risk inducing drugs), increased risk of side-effects and interactions between medications, and also that compliance to prescription might decrease with increased number of prescribed medications," says Moller.
Drugs that affect the central nervous system—antidepressants, hypnotics and opioids—have long topped the list of pharmaceuticals that may increase fall risk, along with diuretics, constipation medications and NSAIDs. The Karolinska study, which tracked the medical records of more than 64,000 Swedes who'd been hospitalized because of a fall, uncovered surprising new links between fall injuries and vitamin B12, calcium, antithrombotics, and GERD and peptic ulcer drugs.
The list of commonly prescribed drugs that may enhance fall injury risk, according to Moller's research, is as follows:
- Antithrombotic agents
- Drugs for peptic ulcer and GERD
- High ceiling diuretics
- NSAIDs (women only)
- Vitamin B12 and folic acid
- Constipation drugs
- Hypnotics and sedatives:
- Analgesics and antipyretics
- Thyroid hormones (men only)
Of course, any medication that causes drowsiness, dizziness, vision problems, gait disturbance (ataxia), hypotension, or one that increases bleeding risk or exacerbates osteoporosis could potentially up the chances of experiencing a harmful fall.
Which causes the fall, disease or drug?
Eliminating these drugs from the prescription repertoire of an aging adult may not be a realistic option. For instance, warfarin, a popular antithrombotic, is highly-effective in inhibiting the formation of dangerous blood clots in people with heart conditions and those who've had a stroke.
Doctors must constantly weigh the benefits and drawbacks of every medication they prescribe, and, in many cases, there are no alternative drugs for them to consider. "Although we can assume that the risk for individual patients to sustain injurious falls would be minimized by not prescribing these medications, they may still remain essential in other critical aspects of health and well-being," Moller explains.
Then there's the chicken-and-egg problem of trying to determine what's to blame for a fall: a particular drug, or the condition that the drug was prescribed to treat. "To develop effective preventive programs it is important to know if it is the medication that increases the risk or the health impairment the medication is prescribed for," says Moller.
Brown bag it
For people taking multiple medications, the importance of discussing prescriptions with your doctor(s) and doing a periodic "brown bag checkup" with your pharmacist cannot be overstated.
AgingCare.com Expert, Dr. Vik Rajan offers the following list of questions to ask your physician to avoid polypharmacy:
- Which medications am I taking and why?
- How necessary is each medication? Can any be removed?
- Could any of these medications be interacting with each other in a negative way?
- Could any of my symptoms or conditions potentially be caused by the medications I'm taking?
Making an appointment with your local pharmacist to bring all of your medications (over-the-counter and prescription) for a "brown bag checkup" is another way to identify possible medication problems.