As people age, the risk of falls significantly increases, with statistics indicating that approximately one in four older adults experiences a fall each year. This alarming trend can lead to serious injuries and fractures, which may result in a decrease in mobility and independence. In fact, falls are the leading cause of fatal and nonfatal injuries among individuals aged 65 and older, accounting for more than 800,000 hospitalizations annually in the United States alone.
Various factors contribute to the heightened risk of falls in older adults, including muscle weakness, balance disorders, and environmental hazards such as uneven surfaces or inadequate lighting. Understanding these risks is crucial for implementing preventive measures that can help safeguard the well-being of older adults.
Factors Contributing to Falls
Frailty: As people age, they become weak, making it difficult to walk long distances and putting them at risk of falling.
Disease: Neurodegenerative diseases, such as Parkinsons disease, are more common in older adults. This alters their coordination, eventually increasing the risk of falls.
Vision impairments: Most older adults have visual disturbances either because of long-lasting complications of diabetes, cataracts, or other health conditions, and they can not anticipate whats precisely in front of them, hence increasing the risk of falls.
Polypharmacy: Patients, when taking more than one medication to manage their various symptoms, are predisposed to falls. For example, a 70-year-old man who is hypertensive and has benign prostatic hyperplasia (BPH) is prescribed telmisartan to manage his blood pressure and tamsulosin- an alpha blocker to manage BPH. The patient complains about severe postural hypotension because of the combined effects of the angiotensin receptor blocker and alpha-blocker. Both medications are necessary for him, but they put him at risk of falls because of severe hypotension. Most older adults have to take more than one medication to manage concomitant health conditions, which contributes to an increased incidence of falls.
Specific medications: Some medications specifically increase the risk of falls because of their actions. Here in this blog, we have summarized those drugs that should be given with caution in the older adult population because they can increase the risk of falls.
Drugs Associated with Increased Risk of Falls in Older Adults
Below are some of the most common drugs for each category that may increase the fall risk.
ACE Inhibitors
- Drugs: Benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik)
- Indications: Hypertension, heart failure, prevention of cardiovascular events, diabetic nephropathy
- How They Increase Fall Risk: This can cause hypotension, particularly orthostatic hypotension, leading to dizziness and increased fall risk.
Angiotensin II Receptor Antagonists
- Drugs: Azilsartan (Edarbi), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), valsartan (Diovan)
- Indications: Hypertension, heart failure, diabetic nephropathy, post-myocardial infarction
- How They Increase Fall Risk: May lead to dizziness or fainting due to blood pressure reduction or fluid imbalance.
Antiarrhythmics
- Drugs: Digoxin (Lanoxin), disopyramide (Norpace)
- Indications: Atrial fibrillation, atrial flutter, heart failure, ventricular arrhythmias
- How They Increase Fall Risk: Can cause bradycardia, arrhythmias, or dizziness, impairing balance and coordination.
Anticonvulsants
- Drugs: Carbamazepine (Carbatrol, Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), valproate (Depakene), phenobarbital (Luminal), pregabalin (Lyrica)
- Indications: Epilepsy, neuropathic pain, bipolar disorder, migraine prophylaxis
- How They Increase Fall Risk: Sedative effects, dizziness, impaired motor coordination, and cognitive dysfunction increase the risk of falls.
Antidepressants
- Drugs: Amitriptyline (Elavil), bupropion (Wellbutrin), sertraline (Zoloft), venlafaxine (Effexor XR)
- Indications: Depression, anxiety disorders, neuropathic pain, insomnia
- How They Increase Fall Risk: Sedation, dizziness, orthostatic hypotension, and impaired judgment contribute to fall risk.
Antihistamines/Antinauseants
- Drugs: Diphenhydramine (Benadryl), meclizine (Bonine), promethazine (Phenergan)
- Indications: Allergic reactions, nausea and vomiting, motion sickness, anxiety, insomnia
- How They Increase Fall Risk: Sedation, dizziness, and confusion from anticholinergic effects impair balance and coordination.
Antiparkinsonian Agents
- Drugs: Levodopa/carbidopa (Sinemet), pramipexole (Mirapex), selegiline (Eldepryl)
- Indications: Parkinsons disease, restless legs syndrome, drug-induced extrapyramidal symptoms
- How They Increase Fall Risk: Dizziness, hypotension, and dyskinesias impair motor function and balance.
Antipsychotics (Atypical)
- Drugs: Risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa)
- Indications: Schizophrenia, bipolar disorder, major depressive disorder (adjunct), agitation
- How They Increase Fall Risk: Sedation, dizziness, and extrapyramidal side effects (e.g., tremors and rigidity) impair mobility and balance.
Antipsychotics (Neuroleptics)
- Drugs: Chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxitane), thioridazine (Mellaril)
- Indications: Schizophrenia, psychosis, agitation, severe nausea and vomiting
- How They Increase Fall Risk: Sedation, impaired coordination, and extrapyramidal effects contribute to instability.
Anxiolytics
- Drugs: Buspirone (BuSpar), Meprobamate
- Indications: Anxiety disorders, short-term anxiety relief
- How They Increase Fall Risk: Sedative effects and impaired motor coordination increase fall risk.
Benzodiazepines (Long-acting)
- Drugs: Diazepam (Valium), chlordiazepoxide (Librium), clonazepam (Klonopin)
- Indications: Anxiety, seizures, muscle spasms, alcohol withdrawal, insomnia
- How They Increase Fall Risk: Cause sedation, dizziness, and muscle relaxation, impairing alertness and coordination.
Benzodiazepines (Intermediate-acting)
- Drugs: Alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril)
- Indications: Anxiety, insomnia, panic disorder, seizure disorders
- How They Increase Fall Risk: Sedation and impaired motor function increase the likelihood of falls.
Benzodiazepines (Short-acting)
- Drugs: Triazolam (Halcion)
- Indications: Insomnia, pre-procedural sedation
- How They Increase Fall Risk: Causes drowsiness, dizziness, and muscle weakness, leading to fall risk.
Beta Blockers
- Drugs: Atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal)
- Indications: Hypertension, angina, heart failure, arrhythmias, migraine prophylaxis
- How They Increase Fall Risk: May cause bradycardia and hypotension, leading to dizziness or fainting.
Calcium Channel Blockers
- Drugs: Amlodipine (Norvasc), verapamil (Calan), diltiazem (Cardizem)
- Indications: Hypertension, angina, arrhythmias
- How They Increase Fall Risk: Hypotension, dizziness, and peripheral edema contribute to instability.
Diuretics
- Drugs: Furosemide (Lasix), hydrochlorothiazide (Microzide), bumetanide (Bumex)
- Indications: Hypertension, heart failure, edema
- How They Increase Fall Risk: Dehydration, hypokalemia, and nocturia increase the likelihood of falls.
Opioid Analgesics
- Drugs: Morphine, Fentanyl, Oxycodone
- Indications: Moderate to severe pain, cough suppression
- How They Increase Fall Risk: Sedation, dizziness, and confusion from central nervous system effects increase fall risk.
Skeletal Muscle Relaxants
- Drugs: Baclofen (Lioresal)
- Indications: Muscle spasms, spasticity from multiple sclerosis, or spinal cord injury
- How They Increase Fall Risk: Sedation and muscle weakness contribute to unsteady gait and balance issues.
Vasodilators
- Drugs: Nitroglycerin (Nitrostat), hydralazine (Apresoline), doxazosin (Cardura)
- Indications: Hypertension, angina, heart failure
- How They Increase Fall Risk: Significant hypotension and dizziness, particularly orthostatic hypotension, increase the risk of falls.
Conclusion
Falls are common in older adults, leading to fractures and injuries, negatively impacting their lives. Often, it happens when more than one medication is being given to manage the condition, and the drugs cause sedation or hypotension.
Prescribing medications to older adults is crucial. Therefore, healthcare providers should weigh the risk of falls against the benefit of the medication and prescribe only if the benefit outweighs the risk. Moreover, effective fall prevention strategies should be taken to prevent falls and associated injuries.
About the Author:
Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.
Mariya is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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