According to the National Council on Aging, falls are the leading cause of fatal and non-fatal injuries in older Americans. In fact, one in four Americans aged 65 and older experiences a fall each year. Preventing falls remains a top priority for seniors, health care providers and family caregivers.
While prevention efforts tend to focus on minimizing environmental hazards and improving mobility, another important contributing factor is often overlooked: prescription and over-the-counter medications. Of the 20 medications that are most frequently prescribed to older adults, researchers from the Karolinska Institutet (KI) medical university in Stockholm, Sweden, have found that over half of these may increase fall injury risk.
Jette Möller, study author and associate professor at the Department of Public Health Sciences at KI, points out that a person’s age, sex and health conditions can all compound fall risk, though these factors are largely uncontrollable. On the other hand, responsible medication management could be a simple way of improving an older adult’s chances of staying safely on their feet.
Medications That Can Cause Falls
Drugs that affect the central nervous system, such as antidepressants, hypnotics and opioids, have long topped the list of pharmaceuticals that may increase fall risk. Diuretics, constipation medications and non-steroidal anti-inflammatory drugs (NSAIDs) have also become notorious for the potential to make patients unsteady on their feet. But by tracking the medical records of more than 64,000 Swedes who’d been hospitalized due to a fall, researchers at KI uncovered surprising new links between fall injuries, medications and even dietary supplements.
Möller and her fellow researchers found that the following prescription drugs, over-the-counter medications and dietary supplements may enhance a senior’s fall risk:
- Antithrombotic agents (antiplatelet and anticoagulant drugs used to prevent blood clots)
- Drugs used to treat peptic ulcers and gastroesophageal reflux disease (GERD)
- High ceiling diuretics (like furosemide)
- Vitamin B12 and folic acid supplements
- Constipation drugs
- Calcium supplements
- Hypnotics and sedatives
- Analgesics and antipyretics
- Thyroid hormones
Of course, any medication that causes side effects like drowsiness, dizziness, vision problems, gait disturbance (ataxia), hypotension (low blood pressure), increased bleeding risk or worsening osteoporosis could potentially increase one’s chances of experiencing a harmful fall.
The Connection Between Polypharmacy and Falls
Polypharmacy is the use of multiple medications typically in an effort to manage one or more chronic medical conditions (multimorbidity). Both multimorbidity and polypharmacy are increasingly common in older populations. According to a 2017 report compiled by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS), nearly 67 percent of Americans aged 65 and older report taking three or more prescription drugs in the last 30 days and 40.7 percent report taking five or more.
“Polypharmacy has been suggested to increase the risk of falls in several ways: increased risks for inappropriate medications (i.e. fall risk inducing drugs), adverse side effects and interactions between medications,” Möller explains. She also notes that compliance with prescription instructions may decrease as the number of medications a person takes increases.
Weighing the Risks and Benefits of Medications
Of course, minimizing an aging loved one’s risk of falling is crucial, but removing any of the above drugs or supplements from their medication regimen may not be a realistic option. For instance, the popular antithrombotic drug warfarin is often necessary for inhibiting the formation of dangerous blood clots in people who have heart conditions and a history of stroke.
Doctors must constantly weigh the benefits and drawbacks of every medication they prescribe, and, in many cases, there are no “safer” 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,” Möller emphasizes.
To complicate matters further, there’s the chicken-and-egg problem of trying to determine what’s to blame for a fall: a drug or the condition that the drug was prescribed to treat. For example, severe arthritis may hinder a senior’s mobility and contribute to falls, but an NSAID prescribed for arthritis pain may also play a role in their fall risk. “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 Möller.
Seek a Brown Bag Check-Up
For seniors who are taking multiple drugs (and the caregivers who help manage their medications), the importance of discussing one’s complete regimen at least annually with a doctor cannot be overstated. Even pharmacists can help identify problems like dangerous drug interactions and duplicate medications. Simply bring a complete list of all prescription and over-the-counter drugs and supplements (or bring all containers in a bag) to the next appointment to discuss potential regimen changes.
AgingCare.com Expert, Dr. Vik Rajan, offers the following list of questions to guide the conversation with a physician or pharmacist:
- Why has each of these medications been prescribed?
- 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 symptoms or conditions potentially be caused by any of these medications?
Sources: The risk of fall injury in relation to commonly prescribed medications among older people—a Swedish case-control study, European Journal of Public Health, Volume 25, Issue 3, June 2015, Pages 527–532; Health, United States, 2017: With special feature on mortality (https://www.cdc.gov/nchs/data/hus/hus17.pdf)