Medication-Related Falls in the Elderly

Abstract

People are living to older age. Falls constitute a leading cause of injuries, hospitalization and deaths among the elderly. Older people fall more often for a variety of reasons: alterations in physiology and physical functioning, and the use (and misuse) of medications needed to manage their multiple conditions. Pharmacological factors that place the elderly at greater risk of drug-related side effects include changes in body composition, serum albumin, total body water, and hepatic and renal functioning. Drug use is one of the most modifiable risk factors for falls and falls-related injuries. Fall-risk increasing drugs (FRIDs) include drugs for cardiovascular diseases (such as digoxin, type 1a anti-arrhythmics and diuretics), benzodiazepines, antidepressants, antiepileptics, antipsychotics, antiparkinsonian drugs, opioids and urological spasmolytics. Psychotropic and benzodiazepine drug use is most consistently associated with falls. Despite the promise of a more favourable side-effect profile, evidence shows that atypical antipsychotic medications and selective serotonin reuptake inhibitor antidepressants do not reduce the risk of falls and hip fractures. Despite multiple efforts with regards to managing medication-associated falls, there is no clear evidence for an effective intervention. Stopping or lowering the dose of psychotropic drugs and benzodiazepines does work, but ensuring a patient remains off these drugs is a challenge. Computer-assisted alerts coupled with electronic prescribing tools are a promising approach to lowering the risk of falls as the use of information technologies expands within healthcare.

Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

“…5 Patients with opioid use disorders have a higher risk of overdose death-both suicide and non-suicide-when taking benzodiazepines. 6,7,35 Senior patients are particularly vulnerable, because benzodiazepines are associated with falls, [36][37][38][39] hip fractures, 12 delirium, 10,11 disability, 13 dementia, 14,15 and motor vehicle accidents. 40 Osteoporosis has been linked to fractures alongside benzodiazepine prescriptions in The referent for odds ratios for diagnoses and other prescriptions is patients who did not have that diagnosis or prescription patients at risk of falls, although no direct relationship between osteoporosis and benzodiazepine prescriptions has been described.…”

Association of psychotropic drug use with falls among older adults in Germany. Results of the German Health Interview and Examination Survey for Adults 2008 – 2011 (DEGS1)

“…Falls among older adults are largely preventable by identifying and controlling particularly modifiable risk factors [4,8,9]. Use of psychotropic drugs has been identified as an independent risk factor for falls in various studies including systematic reviews and meta-analyses [10][11][12][13][14].…”

Impact of a stepwise protocol for treating pain on pain intensity in nursing home patients with dementia: A cluster randomized trial

“…This can also lead to an increased risk of falls (Deandrea et al, 2010; Huang et al, 2012), behavioural and psychological symptoms of dementia (BPSD) such as agitation and aggression (Hurley et al, 1992; Lin et al, 2011; Ahn and Horgas, 2013; Husebo et al, 2013), and depression (Cohen-Mansfield and Taylor, 1998). In addition, undertreated pain affects social interaction, provokes sleep disturbances and reduces quality of life (Giron et al, 2002; Cipher and Clifford, 2004; Cordner et al, 2010).…”