Falls are a complex health issue, especially for older adults, and medications are a major contributing factor. A comprehensive understanding of 'Fall-Risk-Increasing Drugs' (FRIDs) is a critical step in prevention. These drugs can impair balance, slow reaction time, and cause dizziness or confusion, increasing the risk of a tumble. For individuals, particularly those over 65, reviewing and managing medications is a key strategy for fall prevention.
Medications that affect the central nervous system (CNS)
Many of the most commonly cited FRIDs act on the central nervous system, producing sedative or psychotropic effects that can significantly compromise stability.
Sedatives and hypnotics
Prescription sleep aids, or hypnotics, and sedatives are a high-risk category. The calming effect on the nervous system can lead to drowsiness, slowed reaction time, and impaired balance, especially the morning after use.
- Benzodiazepines: Medications like diazepam (Valium) and lorazepam (Ativan) are used for anxiety and insomnia and are strongly associated with increased fall risk.
- "Z-drugs": Newer sleep aids such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) also pose a significant risk, particularly due to next-day drowsiness.
Antidepressants
While essential for managing mental health, many antidepressants can cause side effects that raise fall risk, a concern heightened by the fact that depression itself can also increase fall risk.
- Tricyclic Antidepressants (TCAs): These older antidepressants, such as amitriptyline, have significant anticholinergic and sedative effects that increase the risk of falls.
- Selective Serotonin Reuptake Inhibitors (SSRIs): Commonly prescribed SSRIs like sertraline (Zoloft) and citalopram (Celexa) can also increase risk, especially upon initiation, due to side effects like hyponatremia and dizziness.
Opioids and other pain medications
Opioid painkillers, used for moderate to severe pain, are a major contributor to fall risk. They can cause sedation, dizziness, and impaired cognition. Even nonsteroidal anti-inflammatory drugs (NSAIDs) can have an effect by altering blood pressure, particularly in older adults.
Antipsychotics and anti-seizure drugs
Antipsychotic medications, used for conditions like bipolar disorder and schizophrenia, and anti-seizure (antiepileptic) drugs can cause sedation, dizziness, and blurred vision, contributing to instability.
Medications affecting blood pressure
Maintaining stable blood pressure is critical for preventing falls, and medications that alter blood pressure are another key category of FRIDs.
Antihypertensives
Blood pressure medications, such as beta-blockers and diuretics, can lead to orthostatic hypotension—a sudden drop in blood pressure when moving from a seated or lying position to a standing one. This causes dizziness and lightheadedness, increasing fall risk.
Anti-diabetic medications
Medications that lower blood sugar, including insulin and some oral agents like glipizide, can cause hypoglycemia (low blood sugar). A hypoglycemic episode can lead to unsteadiness, faintness, or passing out, significantly increasing fall risk.
The dangers of polypharmacy and drug interactions
Polypharmacy, commonly defined as taking five or more medications, is a frequent issue among older adults and is strongly linked to fall risk. The danger is twofold:
- Cumulative Side Effects: The sedative or hypotensive effects of multiple medications can combine, creating a greater risk than any single drug would alone.
- Drug-Drug Interactions: Certain combinations of drugs can lead to heightened side effects. For example, combining a sedative with a first-generation antihistamine can amplify drowsiness and confusion.
Comparing high-risk medication categories
| Medication Category | Common Side Effects | Key Mechanisms for Falls | Primary Target Condition(s) |
|---|---|---|---|
| Benzodiazepines & Sedatives | Drowsiness, sedation, dizziness | Impaired CNS function, slowed reaction time | Anxiety, Insomnia |
| Antidepressants (TCAs, SSRIs) | Sedation, dizziness, orthostatic hypotension, hyponatremia | Affects balance, impairs cognition, lowers blood pressure | Depression, Anxiety |
| Opioids | Drowsiness, dizziness, impaired coordination | Impaired CNS function, sedation | Pain Management |
| Antihypertensives | Orthostatic hypotension, lightheadedness | Blood pressure fluctuations upon standing | High Blood Pressure |
| Anti-diabetic Drugs | Hypoglycemia (low blood sugar) | Faintness, loss of consciousness | Diabetes |
| First-Gen Antihistamines | Sedation, blurred vision, confusion | Anticholinergic effects, sedation | Allergies, Colds |
Strategies for managing medication-related fall risk
Preventing medication-related falls involves proactive management and open communication with your healthcare team. Here are key steps:
- Comprehensive Medication Review: Schedule regular appointments with your doctor or pharmacist to review all medications, including prescriptions, over-the-counter drugs, and supplements.
- Deprescribing: When safe and appropriate, a healthcare provider may decide to reduce the dose or discontinue a medication that poses a high fall risk, a process known as 'deprescribing'. A study showed a 66% reduction in falls in patients who discontinued psychotropic drugs.
- Non-Pharmacological Alternatives: Explore alternative therapies for conditions. For example, cognitive behavioral therapy can be an effective alternative to medication for some mental health conditions.
- Monitoring and Awareness: Be aware of potential side effects, especially when starting a new medication. Pay attention to dizziness, drowsiness, or changes in balance and report them immediately to your doctor.
- Address the Underlying Condition: It is important to treat the underlying condition causing the need for medication. However, as noted in the BMC Geriatrics journal, the challenge is balancing medication benefits against potential fall risks.
For more detailed information and resources on managing medication-related fall risk, visit the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative website.
Conclusion
Which medication play a significant role in the risk for falls? The answer is not a single drug, but a wide range of medication classes that affect the CNS, blood pressure, and blood sugar. While these medications serve crucial purposes, their side effects can significantly increase fall risk, especially with polypharmacy. By staying informed, communicating openly with your healthcare providers, and exploring management strategies like deprescribing, individuals can take powerful steps to mitigate these risks and enhance their safety.
