Medications are a two-edged sword for elders. On the one hand, medications contribute greatly to good health, but on the other hand, medications also are a risk factor for falls. Consequently, elders and their caregivers need to be aware of medications causing falls and how to avoid harmful drug effects.
Why Medications Cause Falls
There are several ways that medications contribute to falls:
• Adverse reactions are more common in elders because of changes in the aging body (decreased kidney/liver function) that affects how the body absorbs, metabolizes and eliminates drugs.
• Poor vision; inability to clearly read prescription labels and taking the wrong drug or dose.
• Poor hearing; inability to hear drug directions and taking the wrong drug or dose.
• Memory problems; forgetting to take medications or overdosing on medications.
• Polypharmacy (use of 5 or more prescription medications) can lead to drug-drug interactions. Elders taking 5 drugs or more are at greater fall risk compared with those persons taking fewer medications.
Which Medications Are Risky
All medications (including over-the-counter medications) have the potential to cause falls, but certain medications are more likely to be harmful.
• Medications that seem to be particularly risky include: sedatives and hypnotics; antidepressants; and benzodiazepines. Sedatives and hypnotics are used to treat agitation and insomnia. Antidepressants are used for depression and anxiety. Benzodiazepines (Valium and Xanax) are also used for anxiety. These medications can cause sedation, low blood pressure, or memory problems. This doesn’t mean that these drugs should not be taken, because they can have a calming, sleep-inducing, or mood-elevating effect, but should be used with caution, especially in elders at risk of falling due to underlying health conditions.
• Antihypertensives (blood pressure pills) and diuretics (water pills) can cause low blood pressure and dizziness (especially when getting up from the lying and seated position).
• Nonsteroidal anti-inflammatories (NSAIDs), such as aspirin, may potentially increase the risk of falls because of adverse nervous system effects (confusion, dizziness or light-headedness, drowsiness, and vision impairment).
• Anticoagulants (blood thinners) have been implicated, specifically in causing falling injuries (increase the risk of bleeding).
• Many over-the-counter medications can contribute to falls as well. Some allergy medications sleep aids and cold/cough remedies can have the same effects as prescription drugs (drowsiness) and increase risk of falling.
• If you don’t see a medication that you’re taking listed here, it doesn’t mean that you are safe. Several other drugs can cause falls. The ‘common denominator’ among potentially unsafe drugs is that they all work to depress the nervous system, which makes onr less alert and slower to react. If you are concerned about your medications, talk with your doctor.
• If you see a medication on this list that you or a loved one is talking, DO NOT stop taking the medication on your own. Some drugs can trigger serious side effects if stopped abruptly. It’s best to check with your doctor first.
How to Manage Medications
Elders at fall risk and taking multiple medications need to be extremely cautious with medications. Here are 5 tips to help you manage medications safely:
(1) Keep a Medication List
A medication list is a complete record of all drugs (prescription, over-the-counter, and supplements) that the elder takes. It should include the drug name, size of dosage, directions for how to take it, how often, what it's used for, and any cautions to be aware of. Take the list to all doctor visits, so that every doctor is aware of all medications taken.
(2) Understand Your Medications
Find out as much as possible about every medication taken. Here are some questions to ask whenever a doctor prescribes a medication:
• What is the name, dosage, frequency, and side effects of the medicine?
• Why is this medicine prescribed?
• How does the medicine work in the body?
• Will this medicine interact with other medications?
• When will the medicine begin to work?
• Are there any foods, drugs, or activities to avoid while taking this medicine?
• Do you have written information about the medicine that I can take home with me?
(3) Medication Review
If elders are taking many medications, it’s a good idea to ask the doctor to conduct a regular medication review. The purpose is to assess which drugs are really needed, and determine which might have outlived their usefulness and thus could be eliminated. Asking for a medication review can help prevent harmful side effects and drug-drug interactions.
(4) Fill Prescriptions at One Location
By filling all prescriptions at the same pharmacy, the pharmacist will be aware (and have a record) of all medications taken, and can look out for potential drug interactions. This is critical when elders are seeing several specialists and receiving multiple medications. The pharmacist can also explain what medications do and explain any side effects.
(5) Watch for Physical Changes
Lastly, notify the doctor of any physical changes you may be experiencing, such as difficulty with walking, balance, memory, sleeping, etc. These changes may a sign of an adverse medication effect or the need to adjust or add medications.
Next month’s blog will discuss medication non-adherence and fall risk.
Click here to read Dr. Rein Tideiksaar’s article, “Why is My Balance Worsening?”
Rein Tideiksaar Ph.D., PA-C (or Dr Rein as he is commonly referred to) is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting. To learn more, check out the Doctor’s professional profile on LinkedIn: http://www.linkedin.com/pub/dr-rein/6/759/592. If you have any questions about preventing falls, please feel free to email Dr. Tideiksaar at firstname.lastname@example.org
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