Drug-Related Falls: Are your Elderly Patients at Risk?

Falls constitute a leading cause of injuries, hospitalizations and deaths among the elderly. Medication use is one of the most modifiable risk factors for falls and fall-related injuries. Physiological changes due to aging can significantly affect the absorption, distribution, and metabolism of drugs. These changes include a decrease in lean body mass and increased body fat, decreased serum albumin, and decreased hepatic and renal function. As a result of these physiological changes, elderly patients are at greater risk to experience drug-related side effects such as dizziness, confusion, and sedation even with dosages within normal prescribing guidelines.

When performing the medication reconciliation during office visits, keep in mind some of the common drug classes which could increase fall risk. When appropriate, an attempt should be made to reduce the number and dosage of these medications to ensure they are not causing undue side effects.

Drug Classifications Common Examples Side Effects Contributing to Fall Risk
Benzodiazepines Temazepam, Diazepam, Chlordiazepoxide, Clonazepam, Alprazolam, Lorazepam Drowsiness, slow reaction time, impaired balance
Sedatives-hypnotics Zolpidem, Eszopiclone, Zaleplon Drowsiness, slowed reaction time, impaired balance
Skeletal Muscle Relaxants Cyclobenzaprine, Carisoprodol, Methocarbamol, Tizanidine, Baclofen Drowsiness, dizziness, impaired balance due to reduced muscle tone, confusion
Opioids Hydrocodone, Oxycodone,  Meperidine, Fentanyl, Morphine Drowsiness, dizziness, confusion
Antidepressants/Antipsychotics Amitriptyline, Nortriptyline, Trazodone, Mirtazapine, Olanzapine, Quetiapine, Duloxetine, Fluoxetine, Paroxetine, Venlafaxine Orthostatic hypotension, sedation, slow reflexes, loss of balance
Diuretics Furosemide, Bumetanide, Metolazone, Chlorthalidone, Hydrochlorothiazide Orthostatic hypotension, weakness due to low potassium, hyponatremia, dizziness

Besides the burden on healthcare utilization and costs, falls can significantly reduce the quality of life for many seniors. Elderly patients may continue to experience problems with mobility and other activities of daily living up to several months after a fall. Patients who experience a fall injury may also generate a fear of falling, which has been associated with negative health effects including recurrent falls, reduced physical activity, restriction or avoidance of social activities, and depression.