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Medication-Related Falls in the Elderly

Causative Factors and Preventive Strategies

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Abstract

People are living to older age. Falls constitute a leading cause of injuries, hospitalization and deaths among the elderly. Older people fall more often for a variety of reasons: alterations in physiology and physical functioning, and the use (and misuse) of medications needed to manage their multiple conditions. Pharmacological factors that place the elderly at greater risk of drug-related side effects include changes in body composition, serum albumin, total body water, and hepatic and renal functioning. Drug use is one of the most modifiable risk factors for falls and falls-related injuries. Fall-risk increasing drugs (FRIDs) include drugs for cardiovascular diseases (such as digoxin, type 1a anti-arrhythmics and diuretics), benzodiazepines, antidepressants, antiepileptics, antipsychotics, antiparkinsonian drugs, opioids and urological spasmolytics. Psychotropic and benzodiazepine drug use is most consistently associated with falls. Despite the promise of a more favourable side-effect profile, evidence shows that atypical antipsychotic medications and selective serotonin reuptake inhibitor antidepressants do not reduce the risk of falls and hip fractures. Despite multiple efforts with regards to managing medication-associated falls, there is no clear evidence for an effective intervention. Stopping or lowering the dose of psychotropic drugs and benzodiazepines does work, but ensuring a patient remains off these drugs is a challenge. Computer-assisted alerts coupled with electronic prescribing tools are a promising approach to lowering the risk of falls as the use of information technologies expands within healthcare.

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Acknowledgements

The research for this review and the preparation of the manuscript were not supported by any external funding. The authors have no conflicts of interest that are directly relevant to the content of this article. All authors jointly developed the manuscript content and were involved in at least one of the following: conception, interpretation of data, drafting the manuscript and/or revising the manuscript for important intellectual content. All authors provided final approval of the version to be published.

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Authors and Affiliations

  1. Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada

    Allen R. Huang MDCM, FRCP, FACP, AGSF & Louise Mallet

  2. Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada

    Louise Mallet

  3. Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada

    Christian M. Rochefort, Tewodros Eguale, David L. Buckeridge & Robyn Tamblyn

  4. McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Room M8.12, Montréal, Quebec, Canada, QC, H3A 1A1

    Allen R. Huang MDCM, FRCP, FACP, AGSF

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  1. Allen R. Huang MDCM, FRCP, FACP, AGSF
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  2. Louise Mallet
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  3. Christian M. Rochefort
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  4. Tewodros Eguale
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  5. David L. Buckeridge
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  6. Robyn Tamblyn
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Correspondence to Allen R. Huang MDCM, FRCP, FACP, AGSF.

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Huang, A.R., Mallet, L., Rochefort, C.M. et al. Medication-Related Falls in the Elderly. Drugs Aging 29, 359–376 (2012). https://doi.org/10.2165/11599460-000000000-00000

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