Combination psychotropic medicine use in older adults and risk of hip fracture

Abstract

SUMMARY Older people might be embarrassed to talk about falling as they worry this may be judged as a loss of their ability to live independently. Ask older patients, at least yearly, if they ever feel unsteady on their feet or if they have fallen Consider whether medicines may be contributing to feelings of unsteadiness or falling. Drugs such as benzodiazepines and selective serotonin reuptake inhibitors, particularly if taken together, are associated with a risk of falling and hip fracture Review the patient’s treatment regimen to see if there are drugs that are no longer required. Psychotropic drugs should usually be tapered gradually so that adverse effects can be minimised Involve a range of health professionals to identify and manage the risk of falls. Help patients stay physically active, independent and socially connected

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

“…Similarly, there is no effective pharmacological treatment to slow down ageing and associated frailty, disability, cognitive decline. Importantly, even when we have medications at our disposal for the treatment of common psychological problems such as depression, insomnia, and anxiety (antidepressants, insomniacs, and anxiolytics, respectively), these potentially inappropriate medications (PIMs) may be associated with adverse drug events (ADEs) such as falls, hip fractures, delirium, and worsening of cognitive impairment, which is far less desirable than the use of evidence-based exercise prescriptions to treat these conditions [50]. Thus, the actual utility of exercise as medicine is four-fold: 1) to exploit its potential to prevent diseases for which we have available treatments; 2) to serve as an adjunct to effective medical/ surgical interventions where they do exist; 3) to substitute for hazardous treatments for which exercise represents a better and safer alternative; and 4) to become mainstream in the management of conditions for which there is no other effective treatment.…”

Effect of Multimorbidity on Fragility Fractures in Community-Dwelling Older Adults: Shimane CoHRE Study

“…Various diseases and discomfort have been recognized among the elderly, and, consequently, pharmacotherapy for these diseases can cause public health concerns. Besides steroids [ 5 ], the widespread use of drugs, such as sedatives [ 6 ], psychotropics [ 7 ] and antihypertensives, may increase the risk of falls and fracture. Several other factors can influence bone health, such as lifestyle habits, including physical activity, diet, smoking, and alcohol consumption [ 8 ].…”