Medications and Fall Risk

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MEDICATIONS AND FALL RISK

Pius Amponsah, PharmD Candidate 2019

 

Falls are the leading cause of fatal and non-fatal injuries for older Americans and threaten both safety and independence.  Falling is not a result of aging, but falling once doubles your chances of falling again.1

 

According to the National Council on Aging (NCOA), the CDC older adult fall statistics show:

  • 1 in 4 Americans aged 65+ fall each year, but less than half are reported
  • Every 11 seconds an older adult is treated in the emergency room for a fall
  • Every 19 minutes, an older adult dies from a fall
  • 1 out of 5 falls cause a serious injury such as broken bones or head injury
  • Over 800,000 patients a year are hospitalized because of fall injury2

 

Fall Risk Factors Include:

·         Age

·         Female gender

·         History of previous fall

·         Fear of falling

·         Mobility impairment

 ·         Arthritis

·         Using multiple pharmacies

·         Low blood pressure

·         Vision impairment

·         Pain

 

Medication and falls

  • 72% of people aged 55+ use at least one drug3
  • 3% take 4 or more drugs3
  • Side effects from medications may cause falls leading to hospitalizations in the elderly
  • Older population are at higher risk of medication side effects due to
    • Use of multiple pharmacies
    • Multiple health conditions
    • Cognitive impairment
    • Changes in mental status

 

Falls caused by medication side effects can be modified through medication reviews.

 

Unfortunately, medication-based fall risks are often missed during doctor’s visits.  It is common for older adults to be taking multiple medication associated with increased fall risk.

 

Medication side effects like sedation, impaired balance, reduced reactivity, dizziness, loss of consciousness, low blood pressure and involuntary shaking have been identified to increase fall risk.

 

Older adults are more prone to develop these side effects since they often end up using a higher number of medications to manage multiple disease states.

 

Pharmacists do medication reviews to identify medications that may increase fall risk and modify therapy.

 

Commonly prescribed medications that increase fall risk include:

 

Benzodiazepines: for treating anxiety

– Lorazepam (Ativan)

– Diazepam (Valium)

  

– Temazepam (Restoril)

–  Alprazolam (Xanax)

 

Non-benzodiazepine sedatives/hypnotics (Z-Drugs): Used to treat insomnia

–  Zolpidem (Ambien) –  Zaleplon

(sonata)

 –  EsZopclone (Lunesta)

 

Antipsychotics: Used for behavior control in elderly patients with Alzheimer’s and dementia

–  Aripiprazole (Abilify)

–  clozapine (Clozaril)

 

 –  olanzapine (Zyprexa)

–  quetiapine (Seroquel)

 

 –  risperidone (Risperdal)

–  ziprasidone (Geodon)

 

Opioid analgesics: used to treat pain

–  Hydromorphone (Dilaudid)

–  Oxycodone (Roxicodone)

 –  Oxycodone/acetaminophen (Percocet)

–  Hydrocodone/acetaminophen (Vicodin)

 

Blood pressure Medications: Can cause sudden fall in blood pressure and can increase fall risk

–  Furosemide (Lasix)

–  Hydrochlorothiazide (Microzide)

 –  Spironolactone (Aldactone)

–  Chlorthalidone (Hygroton)

 

These are just a few of the commonly prescribed medications that increase fall risk.

 

What should you do if you or a family member is taking one or more of these medications?

  • Do not panic… contact your doctor to re-evaluate your needs and dosage modifications if appropriate.
  • Your doctor may:
    • STOP certain medications when possible
    • SWITCH to a safer alternative
    • REDUCE the medication to the lowest effective dose.
  • Be active and participate in the process with your healthcare team. Call Bremo Pharmacy for any medication-related questions!

 

Additional resources

  1. Bremo Pharmacy contact page. https://bremorx.com/contact/
  2. 6 Tips to prevent falls. https://bremorx.com/6-tips-to-help-prevent-falls/

 

References

  1. Make STEADI Part of Your Medical Practice | STEADI – Older Adult Fall Prevention | CDC Injury Center. (n.d.). Retrieved from https://www.cdc.gov/steadi/index.html
  2. Falls Prevention Facts. (2018, June 04). Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/
  3. De Jong, M., Van der Elst, M., & Hartholt, K. (n.d.). Drug-related falls in older patients: Implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety., 4(4), 147-154.
  4. Kernisan, L. (2018, October 30). 10 Types of Medication That May Cause Falls in Aging. Retrieved March 6, 2019, from https://betterhealthwhileaging.net/preventing-falls-10-types-of-medications-to-review/

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