Do not underestimate the danger of falling among elderly— more than a third of elderly people fall every year in Malaysia. Falling is known to result in injuries and even deaths for the old people, and it should be taken seriously.
Medications and falls
Why do elderly fall in the first place? An obvious reason is due to old age, which comes with impaired body coordination and balance. However, another often overlooked risk factor that may give rise to higher risk of falling is medications, particularly taking many medications at one time (known as polypharmacy).
Our elderly population is the biggest user group of medications, and they take all sorts of medications — from blood pressure medications, to pain medications and medications for dementia — you name it. Among these medications, there is a group of medications that is associated with significant risk of falls, known as ‘fall risk increasing drugs’. They are:
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Antihypertensive: Medications used in the treatment of high blood pressure. The risk of falling is caused by the drop of blood pressure.
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Diuretics: also known as ‘water pills’, which are used to get rid of excess fluid from the body. They’re commonly used in the treatment of heart failure. As the fluid leaves the body, blood pressure drops and may cause dizziness and falling.
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Beta-blockers: They’re a group of medications that is also part of the antihypertensives, as well as used in the treatment of heart failure. People with anxiety or hyperthyroidism do take beta-blockers as well to reduce tremors and heart palpitations. Similarly, beta-blockers also reduce blood pressure and can cause dizziness.
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Alpha receptor blockers: Commonly used for treatment of prostate problems. They can cause a powerful drop in blood pressure known as orthostatic hypotension that can often lead to fall in elderly.
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Glyceryl trinitrate (GTN): This medication is prescribed for chest pain, of which the patient will put one tablet under the tongue when experiencing chest pain. However, this medication can also quickly reduce blood pressure, hence increasing the risk of falling.
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Sedatives and hypnotics: For the treatment of anxiety, depression or to improve sleep. These medications can cause drowsiness, thus increasing the risk of falling.
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Neuroleptics and antipsychotics: For the treatment of psychosis and other mental health disorders.These medications can cause drowsiness, thus increasing the risk of falling.
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Antidepressants: These medications can cause drowsiness, thus increasing the risk of falling.
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Benzodiazepines: Also frequently used in the treatment of anxiety, depression or to improve sleep. These medications can cause drowsiness, thus increasing the risk of falling.
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Narcotics: Treatment for severe pain. These medications can cause drowsiness, thus increasing the risk of falling.
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Non-steroidal anti-inflammatory agents: a widely used group of medications for pain and fever
Reduce risk of falling among elderly
While some medications do increase the risk of falling among the elderly, falling is a multifaceted problem that requires a multidisciplinary approach. Work with a team of healthcare providers that you trust to reduce fall risk of the elderly under your care:
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Anticipating the circumstances and causes of falls, and finding solutions to counteract those causes
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Critically reviewing and monitoring medication intake (type, number, dose and time of intake)
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Individually designed exercise programmes for the elderly to promote a healthy lifestyle without increasing fall risk
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Carefully (re)assessing the need for assistive and protective aids, and promoting the correct use of these aids
For more tips on how to reduce fall risk among elderly, read our previous article here
A word from Doc2Us
Falling is a public health problem among the elderly, and it deserves our attention and care.
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References
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Woolcott J. Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons. Archives of Internal Medicine. 2009;169(21):1952.
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Neyens J, Dijcks B, Twisk J, Schols J, van Haastregt J, van den Heuvel W et al. A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age and Ageing. 2008;38(2):194-199.
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de Jong M, Van der Elst M, Hartholt K. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety. 2013;4(4):147-154.
Cover image credit: https://www.muhealth.org/our-stories/preventing-falls-older-adults
