Medication and Falls

By Melanie Bunn, RN, MSN, GNP, Lead Trainer and Consultant

Falls can be a life changing experience - for the person who falls and for their care partners. Falls are most often the consequence of combinations of factors, internal and external. Internal factors involve the person and external factors involve the environment.

Internal factors can include the aging process, health conditions, sensory changes (vision and hearing), problems with walking and moving (gait and balance), difficulties with doing self care, depression and cognitive impairment.

External factors might include physical restraints, a move to a new location, slippery or shiny floors, cluttered pathways, unsteady furniture, inappropriate, misused or damaged equipment and poor lighting (glare or too low).

Past History is Key Indicator

Despite all these potential contributors, one key indicator of high risk of future falls is clear - past history of falls; the more falls the greater the risk of falling. Once an older person has fallen, especially if the fall resulted in an injury or seems to be more than a simple trip that could have happened to anyone in the specific circumstances, considering the contributing factors and possible strategies to reduce risk of future falls is a good idea. Simply accepting that "older people are prone to falls" or "she falls all the time" sets the person up for continued falls and injury.

Review and Modification

While falls are one of the most complicated and difficult syndromes to evaluate, one fairly concrete truth exists: the more medications an older person takes, the higher the risk of falling. Research consistently shows that taking more than 3-4 medications per day significantly increases risk for falling. Reducing the numbers and doses of medications is associated with reduction in falls. Thus, including review and modification of drug regimens is an important component of evaluating falls. This doesn't mean automatically and arbitrarily stopping medications; it does mean that careful review and modification is indicated.

While almost all medications, even over the counter drugs, have potential to contribute to falls, research has shown that certain groups of drugs are associated with much higher risk and need special consideration.

• Any central nervous system/psychotropic medications
• Sedative/hypnotics (sleeping medications)
• Antidepressants (especially the tricyclics)
• Antipsychotics/neuroleptics
• Benzodiazapines ("nerve pills")
• Certain cardiovascular drugs
• Diuretics
• Antiarrhythmics
• Cardiac glycosides
• Medications used to treat diabetes

Steps to a good medication review

• Create a list of all medications the person takes and exactly (how?) he/she takes them (remembering that the reality may be quite different from what's written on the bottle).
• Prescription
• Over-the-counter
• Vitamins and other supplements
• Herbs and other "natural" remedies
• Evaluate the medication regimen
• Current health conditions
• Potential medication benefits
• Possible adverse reactions
• Identify potential problems and possible alternatives
• Medications that could be stopped (condition resolved)
• Medications that could be replaced with a similar drug with potentially fewer problems
• Final note: don't forget the alcohol or "recreational" drugs