The National Council on Aging has reported that falls are the primary reason for fatal and non-fatal injuries in older Americans. One in four Americans aged 65 and older experiences a fall annually. Education and fall prevention remain a top priority for seniors, health care providers and family caregivers.
Although preventative efforts focus on reducing environmental hazards and improving mobility, there is another vital factor that is commonly overlooked: prescription and over-the-counter medications. Of the twenty medications that are most often prescribed to older adults, researchers from the Karolinska Institute (KI) medical university in Stockholm, Sweden, have found that over half of these may increase the risk of being injured from a fall. Their research points out that a person’s age, sex and health conditions can all compound fall risk, though these factors are largely uncontrollable. Responsible medication management could be a simple way of improving an older adult’s chance of safely maintaining their balance.
Antidepressants, hypnotics and opioids have long topped the list of pharmaceuticals that may increase fall risk because they affect the central nervous system. Diuretics, constipation medications and non-steroidal anti-inflammatory drugs (NSAIDs) have also become notorious for the potential to make patients unsteady and compromise balance. KI researchers tracked the medical records of more than 64,000 Swedes who’d been hospitalized due to a fall, they uncovered surprising new links between fall injuries, medications and even dietary supplements.
The following prescription drugs, over-the-counter medications and dietary supplements that may increase a senior’s fall risk were among their findings.
- 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
Obviously, any medication that causes adverse effects like, dizziness, drowsiness, blurred vision, gait disturbance (ataxia), low blood pressure, increased bleeding risk or worsening osteoporosis could possibly increase one’s likelihood of suffering from a dangerous fall.
The Affiliation Between Polypharmacy and Falls
Polypharmacy is the simultaneous use of multiple drugs by a single patient, generally in an effort to manage one or more additional medical conditions (multimorbidity). Both multimorbidity and polypharmacy are progressively common in the older adult population. Consistent with a 2017 report compiled by the Centers for Disease and Prevention (CDC) and the National Center for Health Statistics (NCHS), nearly sixty seven percent of American citizens aged 65 and older report taking 3 or more prescribed medications within the last thirty days and forty seven percent report taking 5 or more.
To make matters more complex, there’s the challenge of finding out what is responsible for a fall: a medication or the condition that the medication was prescribed to treat. For instance, severe inflammatory disease, like arthritis, could hinder a senior’s mobility and make them more susceptible to falls. However, an anti-inflammatory drug prescribed for arthritic pain may also factor into their fall risk. Doctors have to continually weigh the advantages and downsides of each medication they prescribe, and, in some cases, there may not be any “safer” options for them consider.
Seek a Brown Bag Check-Up
For older adults who are taking multiple medications (and the caregivers who facilitate their medication management), the significance of reviewing one’s complete medication regimen with their physician(s) at least once a year is extremely important in regards to their health and safety. Pharmacists can also help assess issues like dangerous drug interactions and duplicate medications. Take a list of all prescriptions, over-the-counter medicine and supplements (or bring all containers in a bag) to the next appointment to discuss potential medication adjustments. If an older adult has multiple physicians, it is always a good rule of thumb to be sure there is open communication among all of their healthcare providers and prescribers across the board. Some good questions to ask on the next visit would be:
- Why has each medication been prescribed?
- What is the necessity of each medication? Can any be removed?
- Could any of the medications be interacting with one another in a negative way?
- Could any new or old symptoms or conditions potentially be caused by any of these medications?
Beth Freeman, Marketing and Assistant Executive Director
Cherry Creek Village, Independent Senior Living Community
Attalla, AL 256.691.0866