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On Sept. 23, 2016 — one day after the ninth annual observation of Falls Prevention Awareness Day in the U.S. — the Centers for Disease Control and Prevention (CDC) reported that falls remain by far the leading cause of injuries among adults age 65 and older in the U.S.[1]
The most recent CDC statistics reveal that during 2014, approximately 27,000 older adults died because of falls.[2] Overall, nearly 3 million older adults were treated in emergency rooms for fall-related injuries,...
On Sept. 23, 2016 — one day after the ninth annual observation of Falls Prevention Awareness Day in the U.S. — the Centers for Disease Control and Prevention (CDC) reported that falls remain by far the leading cause of injuries among adults age 65 and older in the U.S.[1]
The most recent CDC statistics reveal that during 2014, approximately 27,000 older adults died because of falls.[2] Overall, nearly 3 million older adults were treated in emergency rooms for fall-related injuries, such as fractures and head trauma, and about 800,000 of these patients subsequently were hospitalized. The costs to Medicare to care for patients who have been injured in falls are estimated to be $31 billion annually. And for many elderly people, fall-related injuries can lead to a loss of independence and placement in an assisted-living facility or nursing home.
Many falls are preventable. In 2011, the CDC launched an initiative called STEADI — Stopping Elderly Accidents, Deaths, and Injuries — to reduce preventable falls in older adults.[3],[4] STEADI provides health care professionals with tools to screen and assess older patients for risk of falls and guidance on how to reduce this risk. A key part of the STEADI program involves health care professionals reviewing and managing patients’ medications that might increase the risk of falling.
The list of drugs that can make patients susceptible to falling is lengthy (see table below). Use of these drugs by older adults should be avoided whenever possible, and many have been designated as Do Not Use by Public Citizen’s Health Research Group. Older adults requiring treatment with one or more of these drugs should use the lowest dose necessary to achieve the desired clinical benefit in order to lower the risk of falling. Note that the table does not include drugs used to treat high blood pressure, all of which can increase the risk of falling.
Examples of Drugs That Cause Falls
| Drug Family | Examples |
|---|---|
| Antidepressants |
Selective serotonin reuptake inhibitors (SSRIs)
|
| Antiemetic (anti-nausea) drugs |
|
| Antihistamines |
|
| Antipsychotics |
Atypical antipsychotics
|
| Benzodiazepines |
|
| Coronary artery disease/angina drugs |
|
| Epilepsy (seizure) drugs |
|
| Flozin diabetes drugs (sodium glucose transporter 2 inhibitors) |
|
| Muscle relaxants |
|
| Opioids |
|
| Other sleeping pills and tranquilizers |
|
| Prostate enlargement drugs |
First-generation alpha-blockers
|
| Smoking cessation drugs |
|
NOTE: This table does not include blood pressure drugs, all of which can increase the risk of falls.
*Limited Use
**Do Not Use
***Do Not Use, except for panic disorder †Other active ingredients are present in the brand-name product
How drugs cause falls
Drugs can increase the likelihood of falling in several ways. Some drugs — such as high blood pressure medications, alpha-blockers for benign prostate enlargement, and the newest class of diabetes drugs, known as flozins — can cause low blood pressure, particularly upon standing, which can lead to dizziness and fainting.
Drugs that act on the nervous system, such as benzodiazepines, sleeping pills and other tranquilizers, can cause daytime drowsiness, dizziness, confusion, blurred vision, decreased depth perception and reduced muscle coordination. Each of these side effects increases the likelihood of tripping, losing one’s balance and falling.
What You Can Do
If you are 65 or older, whether or not you have previously fallen, ask your doctor to assess your risk for falling and develop a plan to reduce that risk. As part of this assessment, you should review all of your medications and identify any that are known to increase the risk of falling. Let your doctor know if you are experiencing any side effects, such as feeling dizzy, unsteady or sleepy. Tell your doctor right away if you experience a fall.
If you are taking any drugs linked to falling, ask your doctor about whether there are alternative drugs that could be used or whether the dose of your drug(s) could be reduced. Also, talk to your doctor about whether you should be on a vitamin D supplement. Vitamin D is important for bone and muscle health, and vitamin D deficiency has been linked to falls and fall-related injuries. Whenever you start a new drug or increase the dose of a current drug that has been linked to falling, be especially alert for new symptoms, such as dizziness, and be cautious when initially sitting up or standing.
Engage in activities that strengthen your leg muscles and improve your balance (such as tai chi). Have your vision checked once a year and replace your eyeglasses as needed. Finally, make your home safe by:
- Keeping your floors clutter free.
- Removing small rugs or securing them with tape.
- Adding grab bars in the bathroom.
- Having handrails and lights installed on all staircases.
- Making sure your home has lots of light.
References
[1] Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged ≥65 years — United States, 2014. MMWR. 2016;65(37):993-998.
[2] Ibid.
[3] Centers for Disease Control and Prevention. STEADI – Older adult fall prevention. Updated September 22, 2016. http://www.cdc.gov/steadi/index.html. Accessed October 11, 2016.
[4] Casey CM, Parker EM, Winkler G, et al. Lessons learned from implementing CDC’s STEADI falls prevention algorithm in primary care. Gerontologist. April 26, 2016 (online). http://dx.doi.org/10.1093/geront/gnw074.
