These days most people are aware that falls and fall prevention are a huge focus of the senior care industry. Helping adults aged 65 and older retain their strength, flexibility and balance is a national imperative because falls are often the gateway crisis that cost all of us in many ways.
For example, it is estimated that about a third of those over age 65 have experienced a fall-related injury. The total healthcare costs on falls (fatal and nonfatal) in the United States in 2000 were US$19.2 billion. Fractures are the most expensive type of injury, accounting for 61% of costs [Stevens et al. 2006].
For the past few decades inappropriate medication use has been acknowledged as one of the major factors contributing to falls. Indeed, research in the 1990s showed that up to one-quarter of community-based residents and 40 percent of nursing home populations received at least one medication considered inappropriate.
What are some of the culprit medications?
Researchers in Sweden found that of the 20 medications that are most frequently prescribed to older adults, over half may increase fall injury risk. Of course, a person’s age, sex and overall health contribute tremendously to a person’s risk of falls, the researchers suggest greater awareness and monitoring of certain drugs may help prevent some falls.
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 has 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. Surprising new links have also been uncovered between fall injuries and vitamin B12, calcium, antithrombotics, and GERD and peptic ulcer drugs.
Of course, the Catch-22 is that doctors must constantly weigh the benefits and drawbacks of every medication they prescribe. “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.
The National Institute of Health (NIH) suggests seniors, their families and physicians review medications on a regular basis. Are any duplicate therapies? Can any be eliminated?
Everyone needs to be responsible and vigilant about the potential for bad falls due to medication interactions. Medication regimens should be reevaluated every time a new medication is added or subtracted.