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Falls are one of the most common and serious health concerns affecting older adults. They often lead to injuries such as fractures, head trauma, or even long-term disability. While environmental hazards and muscle weakness are well-known risk factors, a less visible but significant contributor to falls is medication use, especially in older adults with multiple health conditions.
Medications and falls: A growing concern
Globally, about one in three people over the age of 65 falls each year, and this risk increases with age and frailty. Among these incidents, medications play a substantial role. Studies suggest that medications are implicated in up to 30% of all elderly falls, with psychoactive and cardiovascular drugs being the most common culprits. Unfortunately, these drug-related risks are often under-recognised by both caregivers and clinicians.
Polypharmacy and the elderly
Polypharmacy is defined as the use of five or more medications, it is highly prevalent in older adults. In many developed countries, including Singapore, more than 40% of older adults are on multiple medications daily. While many of these drugs are essential for managing chronic diseases, the combined side effects and drug-drug interactions can significantly increase the risk of dizziness, confusion, low blood pressure, and falls.
Common fall-related medications
Several classes of medications are known to increase fall risk:
Benzodiazepines (e.g., diazepam, lorazepam)
Used to treat anxiety and insomnia, these drugs can cause drowsiness, slowed reflexes, and impaired balance, particularly in older adults. They also have a “doubling effect” due to age-related sensitivity and slower metabolism.Antidepressants (e.g., amitriptyline, sertraline)
While helpful for mood disorders, they may cause orthostatic hypotension (a sudden drop in blood pressure when standing), dizziness, and sedation.Antipsychotics (e.g., risperidone, quetiapine)
Often prescribed for behavioural symptoms in dementia, these drugs may lead to sedation, unsteadiness, and confusion.Antihypertensives and diuretics (e.g., amlodipine, furosemide)
Used to manage blood pressure and heart failure, these medications can result in low blood pressure, dehydration, and electrolyte imbalance, contributing to fainting and weakness.Opioids (e.g., morphine, codeine)
While effective for pain relief, opioids commonly cause sedation, dizziness, and slowed reaction time, making falls more likely.Hypoglycemics (e.g., insulin, sulfonylureas)
Used to manage diabetes, these can lead to low blood sugar, resulting in confusion or fainting spells.
How to reduce medication-related falls
Addressing this issue requires a proactive and multidisciplinary approach:
Medication reviews
Regularly assess all medications with a pharmacist or geriatrician, especially after hospital admissions or new prescriptions.Deprescribing
Where appropriate, reduce or stop high-risk medications gradually, particularly sedatives and long-acting drugs.Use clinical tools
Apply criteria like the Beers Criteria or STOPP/START guidelines to identify potentially inappropriate medications in older adults.Monitor closely
Pay attention to side effects such as drowsiness, dizziness, or confusion. Encourage older adults and caregivers to report new symptoms.Explore alternatives
Use non-drug therapies where possible, such as cognitive behavioural therapy for insomnia or anxiety, and physiotherapy for pain or mobility issues.
Conclusion
Medication-related falls are a preventable yet often overlooked risk in older adults. While medications play a vital role in managing chronic diseases, their side effects can quietly compromise safety and independence. Through regular medication reviews, safer prescribing practices, and greater awareness among healthcare providers and caregivers, we can help older adults stay on their feet, and live healthier, more independent lives.