Falls in the elderly can have much more damaging affects than falls in younger populations. This is because older individuals’ ability to heal and recovery from any injury caused by the fall decreases. Therefore, it is very important to decrease anything that can pose as an increased risk for falls. This includes environmental changes (rugs, uneven floor levels, stairs, slick surfaces), health concerns (vestibular/hearing impairments, neurological deficits, spatio/proprioceptive disorders), and medications or substances (i.e. alcohol) that could cause impairment in balance and spatial awareness.
This article will highlight common prescription medications that can increase fall risk in the elderly. It is important if you prescribed any of these medications, or if your physician wants to put you on them, that you recognize this fall risk. Talk with your physician about how to avoid falling while taking this medication, as well as any preventative measures you can take.
Medications that affect the brain
There are many medication classes that affect the brain. These medications increase fall risk because they may alter your awareness of what is going on around you or how your body moves through space. They may also reduce your alertness or the chemical processes that take place when your nerves transmit signals from your brain to your arms and legs, and back.
One class of these drugs are benzodiazepines (benzos for short). They are often prescribed to help people sleep or for anxiety. However, they are habit forming, and have been associated with developing dementia. Commonly prescribed drugs end with “pam” which is how you can recognize them, and include: Lorazepam (ativan), diazepam (valium), temazepam (restoril) and alprazolam (xanax). It is dangerous to stop these medications suddenly, as it can lead to withdrawal (similarly to alcohol withdrawal). Therefore, if you are concerned about safety, then speak with your doctor about this prescription, and maybe even discuss some alternatives if you find yourself feeling very dependent on them.
Other medications that are also used to help with sleep include sleeping medications (ambien, sonata, and lunesta) all of which start with “Z”, which is how you can recognize them. These have been shown to impair balance, so it’s important go straight to bed if you take one of these medications for sleep.
Antipsychotics are medications used to treat schizophrenia, or other illnesses with psychosis symptoms. They are prescribed to Alzheimer’s patients and sometimes those with depression. Some common names are Risperdal, Seroquel, Zyprexa, and Abilify. Another class of antipsychotics include haloperidol, which is known as Haldol.
Anti-seizure medication, or mood stabilizers, can also increase fall risk. They are used to stabilize moods like bipolar disorder or difficult dementia symptoms. They also can be used to treat certain types of nerve pain. Valproic acid, and gabapentin are two common drugs that are used for mood stabilizing and seizures, respectively, that have an increased risk for falls.
Antidepressants, selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat clinical depression. Sertraline, citalopram, escitalopram, paroxetine and fluoxetine (Zoloft, Celexa, Lexapro, Paxil and Prozac are their respective brand names), are all examples of SSRIs that can increase fall risk. Tricyclic antidepressants (including amitriptyline and nortriptyline) are also medications that can cause balance issues. All antidepressants have been associated with an increase in fall risk.
Opioid analgesics are normally used for pain. These include codeine, hydrocodone, oxycodone, morphine, fentanyl and methadone. These cause drowsiness and can be habit forming. Narcotic use is associated with increased risk of falls and injuries.
Anticholinergics are another class of sleeping aids, as well as drugs to help with other health issues. They block a neurotransmitter called acetylcholine, which is responsible for signaling to the neurons in your muscles to contract, among other functions. With these being blocked, you can see how it may increase miscommunication, or lack of communication, between your brain and muscles, making falling a much more common incident. Common examples include drowsy antihistamines (benadryl), the PM version of the the counter analgesics (Nyquil and Tylenol PM). Motion sickness medication or allergy medications also fall under this category of drugs. They commonly cause sedation and have been associated with developing dementia.
Medications that affect blood pressure
Medications that lower blood pressure can increase fall risk as they reduce the perfusion, or blood flow, the vital organs – including the brain. Without adequate blood flow, it is the body’s natural reaction to fall out, or faint, which can lead to an increased risk of injury. Individuals may hit their heads, or hurt themselves if they faint in an area that is full of objects that could cause harm. Brain bleeds could also be a cause of death if someone were to hit their heads while fainting.
Antihypertensives, or medications that those with high blood pressure (greater than 120/80 on average) take to try and manage their blood pressure. This is important as a too high blood pressure can cause several health issues.
Although high blood pressure medications have not been shown to have a direct link to falling and increased injury, polypharmacy (being prescribed multiple drugs that do the same thing) can increase risk for an adverse event. Therefore, if you are on several medications, talk with your doctor about how best to collate the medications that do the same thing so you can reduce the number.
One class of medications that impact blood pressure are called alpha blockers. They end with -osin, and are commonly prescribed for benign prostatic hypertrophy. They can lead to increase risk of falls, especially in men. So, it’s important to talk with your doctor about how to best manage all of the medications that could impact your blood pressure.
Medications that lower blood sugar
One final group of medications that can increase one’s fall risk are those that lower blood sugar. Many older adults with diabetes take medications to stop their blood sugar from getting too high. If blood sugar is not managed appropriately, then diabetics are at increased risk for diabetic retinopathy, which can lead to blindness, macrovascular events (strokes and myocardial infarctions), and chronic kidney disease, which can eventually result in renal failure. Therefore, it’s important to adequately manage blood sugar.
Diabetic medication can lower the blood sugar to a level of hypoglycemia, which can induce fainting. If you have had more than one hypoglycemic spell, then it’s important to talk to your physician, as your A1C target may be too low, and you may be removing too much glucose from your bloodstream.
The important thing is to talk with your doctor to avoid falling, and subsequent disability from injuries. If you do end up falling, and need help completing your activities of daily living, medication dispensing, or transportation to and from your appointments, then please visit our services page to see if Diverse Health Services can assist you in anyway.
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