Does polypharmacy increase falls risk? A Guide to Medication Safety

According to the Centers for Disease Control and Prevention (CDC), about one-third of older adults experience a fall each year. A significant contributing factor to this statistic is the increased use of prescription and over-the-counter medications, prompting the question: does polypharmacy increase falls risk? The authoritative answer confirms a strong association, though the nuances are key to prevention.

Quick Summary

Yes, polypharmacy is strongly associated with an increased risk of falls due to side effects like dizziness, sedation, and cognitive impairment, along with complex drug-drug interactions. While the number of medications is a factor, the specific types of drugs, particularly those categorized as fall-risk-increasing drugs (FRIDs), often have a more direct impact.

Key Points

• Polypharmacy is a risk factor: Taking multiple medications, particularly five or more, is associated with a higher risk of falls in older adults.

• The type of medication matters more: Specific Fall-Risk-Increasing Drugs (FRIDs) like sedatives and antidepressants are often more significant predictors of falls than the total number of medications alone.

• Drug interactions are a key mechanism: The cumulative effect of multiple drugs can lead to adverse side effects like dizziness, sedation, and low blood pressure, all contributing to instability.

• Medication review is essential: Regular, comprehensive medication reviews by a healthcare provider can identify potentially inappropriate medications and reduce unnecessary risks.

• Deprescribing is a critical strategy: Safely reducing or discontinuing certain medications under medical supervision can be a highly effective method for preventing falls.

• Involvement of patients and caregivers is key: Educating patients about side effects and potential risks, and empowering them to communicate with their healthcare team, is a crucial part of fall prevention.

What Is Polypharmacy?

Polypharmacy is generally defined as the use of five or more medications, although some definitions vary. This common condition among older adults often arises from managing multiple chronic health issues simultaneously. While intended to treat specific conditions, the cumulative effect of these drugs can lead to unintended consequences, including an elevated risk of falls.

The Mechanisms Behind Increased Falls Risk

The connection between polypharmacy and falls is complex, involving several physiological mechanisms. These risks are amplified in older adults due to age-related changes in the body, such as altered drug metabolism and reduced physiological reserves. Key factors include:

• Side Effects: Many medications have side effects that directly affect balance, coordination, and mental clarity. Common examples include dizziness, drowsiness, sedation, and blurred vision, all of which compromise a person's stability.
• Orthostatic Hypotension: This is a sudden drop in blood pressure when moving from a sitting or lying position to a standing one. Many drugs, especially those for blood pressure, can cause this, leading to lightheadedness and fainting.
• Cognitive Impairment: Certain drugs can impair cognitive function, affecting judgment and attention. This can reduce a person's awareness of their surroundings and ability to react to hazards, significantly increasing falls risk.
• Drug-Drug Interactions: When multiple medications are taken, the risk of negative drug interactions increases. These interactions can enhance the adverse effects of individual drugs or create new, unexpected side effects.

Fall-Risk-Increasing Drugs (FRIDs) and Key Culprits

While the sheer number of medications is a concern, research suggests that the type of medication may be an even more significant predictor of falls. A key focus is on Fall-Risk-Increasing Drugs (FRIDs), which are well-known to impact fall risk. Classes of drugs frequently identified as FRIDs include:

• Antidepressants: Especially those with sedative effects, these drugs can increase fall risk due to dizziness or unsteadiness.
• Benzodiazepines and Z-drugs: Used for anxiety and insomnia, these sedatives and hypnotics can cause drowsiness and impaired balance, especially with long-term or new use.
• Antipsychotics: These medications can cause orthostatic hypotension and sedation, contributing to an increased fall risk.
• Antiepileptics (Anticonvulsants): Used to prevent seizures, they can have sedative side effects and contribute to bone thinning, increasing fracture risk in a fall.
• Opioids: Used for pain management, these can cause sedation, dizziness, and cognitive issues, making falls more likely.
• Cardiovascular Agents: Diuretics, beta-blockers, and other blood pressure medications can contribute to orthostatic hypotension.

Comparison of Appropriate vs. Inappropriate Polypharmacy

It's important to distinguish between polypharmacy that is necessary for complex conditions and prescribing that is potentially inappropriate and carries unnecessary risk. The goal is not to eliminate all medications but to optimize the regimen for safety and effectiveness.

Feature	Appropriate Polypharmacy	Potentially Inappropriate Polypharmacy
Purpose	Necessary to treat complex, multimorbid conditions with clear benefits outweighing risks.	Excessive or unnecessary medication use with limited clinical benefit and high risk of adverse effects.
Prescribing	Carefully considered, evidence-based, and regularly reviewed by a multidisciplinary healthcare team.	Prescribing cascade (one drug's side effect is treated with another drug), lack of regular review, or use of fall-risk-increasing drugs without proper justification.
Patient Involvement	Patient and family are educated and empowered, actively involved in the decision-making process.	Patient may be unaware of or not counseled on the full spectrum of medication side effects and interactions.
Example	An elderly patient with diabetes, heart disease, and high cholesterol taking multiple medications, each with a proven benefit, under close medical supervision.	A patient taking a sleeping pill long-term when non-pharmacological methods would be safer and just as effective.

Strategies for Reducing Fall Risk Related to Polypharmacy

Managing medication-related fall risk requires a proactive, collaborative approach between patients, families, and healthcare providers. Effective strategies include:

1. Comprehensive Medication Review: Regularly review all medications, including over-the-counter drugs, supplements, and herbal remedies, with a doctor or pharmacist. This process helps identify potential FRIDs and interactions.
2. Deprescribing: Safely reducing or stopping medications that are no longer necessary or have higher risks than benefits. This should always be done under the guidance of a healthcare professional.
3. Patient Education: Educate patients and caregivers about potential side effects, especially concerning dizziness, drowsiness, and cognitive changes. Empower them to report any new or unusual symptoms.
4. Non-Pharmacological Interventions: Explore non-medication alternatives for conditions like insomnia or pain. Physical therapy, occupational therapy, and home modifications are crucial parts of a comprehensive fall prevention plan.
5. Team-Based Approach: Foster communication among all healthcare providers involved in a patient's care to ensure everyone is aware of the full medication list and potential risks.

For more information on fall prevention, including practical advice for home safety, you can visit the CDC's STEADI program website.

Conclusion

Yes, polypharmacy does increase falls risk, particularly in older adults who are more vulnerable to medication side effects. However, the risk is not just about the number of pills but about the specific types and combinations of medications. By working closely with healthcare providers, focusing on appropriate prescribing, and exploring deprescribing options, it is possible to significantly mitigate this risk. A comprehensive, patient-centered approach that prioritizes medication safety is essential for healthy aging and fall prevention.

Frequently Asked Questions

What is polypharmacy and how is it related to falls?

Polypharmacy is the use of multiple medications, often defined as five or more. It increases fall risk because the combined side effects and drug interactions can lead to dizziness, sedation, and impaired balance, especially in older adults.

Are all medications equally risky for falls?

No, certain types of medications known as Fall-Risk-Increasing Drugs (FRIDs) are more strongly linked to falls. These include sedatives (like benzodiazepines), some antidepressants, antipsychotics, and certain cardiovascular drugs.

How can I tell if a medication increases fall risk?

You should discuss this with your doctor or pharmacist. They can review your medication list and identify any drugs that may cause side effects like dizziness, drowsiness, or affect your blood pressure. Don't stop taking a medication without consulting a professional.

What is deprescribing and does it help reduce fall risk?

Deprescribing is the process of safely reducing or stopping a medication. When a medication is no longer necessary or its risks outweigh its benefits, deprescribing can be a crucial strategy for lowering falls risk, but it must be medically supervised.

Besides medication, what are other risk factors for falls in seniors?

Other risk factors include lower body weakness, poor vision, balance problems, home hazards (like uneven steps or clutter), and chronic health conditions such as arthritis or Parkinson's disease.

What steps should I take if I am concerned about polypharmacy and falls?

Start by talking to your healthcare provider about a comprehensive medication review. They can assess your current regimen, discuss potential risks, and explore non-pharmacological alternatives or deprescribing options to reduce your risk.

Can over-the-counter medications and supplements also increase fall risk?

Yes, over-the-counter medications, supplements, and even herbal remedies can interact with prescribed drugs and contribute to adverse effects that increase fall risk. It is important to include these in any medication review with your doctor or pharmacist.