Medication Review for Fall Prevention Programs That Work

Accept you been concerned about falls for yourself, or for an aging parent?

If so, do you know if whatsoever of your medications might be increasing your risk for falls?

In its Stay Independent brochure, the Centers for Disease Command (CDC) recommends older adults exercise the post-obit iv things to prevent falls:

1. Ask your doctor or pharmacist to review your medicines.
2. Brainstorm an exercise program to improve leg strength and residual.
3. Get annual eye check-ups and update your glasses.
4. Make your domicile safer.

In this article, nosotros'll focus on medications for three reasons:

• Medications are amidst the most common causes of increased fall risk in older people.

• Medications are usually among the easiest risk factors to change, when it comes to falls in older adults.

• Medication-based risks are oftentimes missed by busy regular doctors. Older adults and family caregivers tin make a big deviation by being proactive in this surface area.

I want you to sympathise just what types of medications y'all and your doctors should be looking for, when you address medication review as role of fall prevention. This commodity will besides explicate exactly what to do, once you've identified any medications that are associated with falls.

Why review your medications for autumn prevention?

The purpose of medication reviews is to identify medications that might exist increasing fall risk.

In one case you've identified these medications, healthcare providers are supposed to work with you to try to reduce or eliminate the use of such medications. This process is called "deprescribing" and y'all can acquire more here: Deprescribing: How to Be on Less Medication for Healthier Crumbling.

At a minimum, during a medication review for autumn prevention, you and your clinicians should reconsider these medications and confirm that the likely benefits outweigh the probable risks of taking the drug.

Subsequently in this article, I will explain how you and your clinicians should consider stopping, switching, or reducing whatever medications that increase fall risk, or are otherwise risky for older adults.

But first, let me explicate which medications you and your doctors should be looking out for.

3 categories of medication that should be reviewed to prevent falls

You may — or may non — be surprised to know that it's extremely mutual for older adults to be taking medications that have been associated with increased fall risk.

These medications generally fall into one of two three wide categories:

• Medications that affect the brain. Health professionals often refer to these drugs as "psychoactives." These are drugs that touch brain function. Many tend to crusade some sedation or drowsiness.
  • They can also crusade or worsen confusion, particularly in people with memory problems or Alzheimer'south disease.
  • Virtually of them are included on this list: 4 Types of Medication to Avoid if You lot're Worried About Retentiveness.
  • Most of these medications are listed in the2019 American Geriatrics Society Updated Beers Criteria: Medications that Older Adults Should Avert or Use with Caution.

• Medications that touch blood force per unit area. These are drugs that can cause or worsen a sudden fall in blood pressure (BP). A drib in BP — or chronically low BP — can increment fall hazard.
  • Older adults can easily experience a drop in claret pressure when they stand up. This is chosen postural (or orthostatic) hypotension .
  • Most medications for high claret pressure can cause or worsen postural hypotension.
  • Medications such every bit tamsulosin (brand name Flomax) and related medications to improve urination can also cause postural hypotension.

• Medications that lower claret carbohydrate. This is simply a consideration for older adults with diabetes. But as this status affects an estimated 25% of people over historic period 65, these medications are relevant to many seniors.
  • People with diabetes have a higher risk of falls compared to others of the aforementioned age.
  • Hypoglycemia (low claret sugar) due to medications is ane of many factors that has been associated with falls in people with diabetes.

Below, I share my list of ten mutual types of medications associated with falls.

If you've been concerned about falls and want to request a medication review, this list volition assistance y'all identify medications to discuss with your healthcare team.

ten Commonly Used Types of Medications that Increase Autumn Risk in Older Adults

This listing is mainly based on the CDC's flyer Medications Linked to Falls and the American Geriatrics Society'due south Clinical Practice Guidelines on Fall Prevention.

Medications that affect the encephalon ("psychoactives")

1.Benzodiazepines. This class of medication is often prescribed to assistance people slumber, or to help with feet. They do work for this purpose, only they are habit-forming and have been associated with developing dementia.

• Unremarkably prescribed benzodiazepines include lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively)
• Clinical research studies consistently find that benzodiazepines are associated with increased autumn risk.
• For more on the risks of benzodiazepines, plus a handout proven to help seniors reduce their use of these drugs, run across "How You Can Assist Someone Stop Ativan."
• Notation that information technology tin can be dangerous to terminate benzodiazepines suddenly. These drugs should always be tapered, under medical supervision.

2. Non-benzodiazepine prescription sedatives. These drugs are usually prescribed to treat insomnia or slumber difficulties.

• This grouping includes the "z-drugs": zolpidem, zaleplon, and eszopiclone (brand names Ambien, Sonata, and Lunesta, respectively).
• These take been shown in clinical studies to impair balance — and thinking! — in the short-term.

3. Antipsychotics. These are medications originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms. They are normally prescribed to control difficult behaviors in Alzheimer'southward and other dementias. (Learn more near why this is problematic in 5 Types of Medication Used to Care for Difficult Dementia Behaviors.) They are besides sometimes prescribed to people with low.

• Commonly prescribed antipsychotics are mainly "2nd-generation" and include risperidone, quetiapine, olanzapine, and aripiprazole (Risperdal, Seroquel, Zyprexa, and Abilify, respectively).
• The first-generation antipsychotic haloperidol (Haldol) is still sometimes used.
• Clinical research indicates that antipsychotics are associated with increased falls.

4. Anticonvulsants/Mood-stabilizers. Most of these drugs were originally developed to treat seizures. They are also used to stabilize mood in weather condition such as bipolar disorder, and to care for difficult dementia behaviors. They can also be used to treat sure types of nervus pain.

•  Valproic acid (make proper name Depakote) is a mood stabilizer that is sometimes used to manage difficult behaviors in Alzheimer's or other dementias.
• Clinical research suggests that anticonvulsants are associated with increased autumn risk. They also tend to have many other problematic side-effects in older adults.
• Gabapentin (Neurontin) is some other seizure medication that is often used to treat nerve pain. Some inquiry suggests information technology may non affect balance as much every bit some other anticonvulsants.

5. Antidepressants.These are medications prescribed to treat depression. Some of them are too used to treat anxiety.

• Selective serotonin-reuptake inhibitors (SSRIs) include sertraline, citalopram, escitalopram, paroxetine, and fluoxetine (brand names Zoloft, Celexa, Lexapro, Paxil, and Prozac, respectively).
• Other antidepressants ordinarily used include mirtazapine, bupropion, and venlafaxine (brand names Remeron, Wellbutrin, and Effexor, respectively).
• Tricyclic antidepressants include amitryptiline and nortriptyline (brand names Elavil and Pamelor, respectively).
  • These antidepressants are quite anticholinergic and are no longer often used to treat depression. They are however used to manage nerve pain.
• Trazodone is an older antidepressant that is at present used almost exclusively every bit a mild sleep aid.
• Almost all antidepressants have been associated with an increase in autumn chance.

vi. Opioid (narcotic) analgesics. Opioids are mainly used for the treatment of pain.

• Commonly used opioids include codeine, hydrocodone, oxycodone, morphine, fentanyl, and methadone.
• Opioids oft cause drowsiness, as well equally other side-effects.
• Clinical research on the association between opioids and increased fall risk in older adults has shown mixed results. A 2009 meta-assay of medications and fall risk did not find that opioids were associated with falls. Still, a 2020 meta-analysis of opioids did find an association with falls, fall injuries, and fractures.
• Almost experts — including the CDC — recommend that narcotic utilise be evaluated as function of fall risk management.

7. Anticholinergics.This grouping covers about over-the-counter sleeping aids, as well as a variety of other prescription drugs. These are medications that have the chemic belongings of blocking the neurotransmitter acetylcholine.

• A large number of drugs of different classes accept strong anticholinergic activity. (Run across hither for a comprehensive list.) They include:
  • Sedating antihistamines, such equally diphenhydramine (make name Benadryl).
  • The "PM" versions of over-the-counter analgesics (e.g. Nyquil, Tylenol PM); the "PM" ingredient is ordinarily a sedating antihistamine.
  • Medications for overactive bladder, such as the bladder relaxants oxybutynin and tolterodine (brand names Ditropan and Detrol, respectively).
  • Medications for vertigo, move sickness, or nausea, such as meclizine, scopolamine, or promethazine (brand names Antivert, Scopace, and Phenergan).
  • Oral medications for itching, such equally hydroxyzine and diphenhydramine (brand names Vistaril and Benadryl).
  • Musculus relaxants, such every bit cyclobenzaprine (brand name Flexaril).
  • "Tricyclic" antidepressants and also the SSRI paroxetine (make name Paxil)
• Anticholinergics commonly crusade sedation. They can too cloud thinking and have been associated with developing dementia.
• Clinical research on anticholinergics and fall risk has shown mixed results. A 2015 clinical found that the clan was non statistically significant. Nonetheless, more contempo studies (such as here and here) have plant an association.
• Given that anticholinergics tin cause drowsiness and are risky for older adults for other reasons, many experts believe it's reasonable to include them when reviewing medications for fall prevention.

Medications that affect blood pressure level

8. Antihypertensives. A large number of different medications are commonly used to treat loftier blood pressure.

• For a listing of antihypertensive medications, organized by class of drug, see "Types of Blood Pressure Medications."
• Clinical inquiry on blood pressure (BP) medications and fall risk has shown mixed results. Although 1 study constitute that BP medications were associated with injurious falls, another contempo report plant no clan between BP medications and falls. Some research suggests that diuretics may be associated with higher fall adventure than other classes of BP medication. Meta-analyses accept generally been unable to confirm that antihypertensives increase fall take chances.
• Despite the mixed clinical evidence, many geriatricians and other experts exercise recommend re-evaluating BP medications in older adults at high take a chance for falls. I describe a process for doing so here: 6 Steps to Ameliorate High Claret Pressure Treatment for Older Adults.

9. Other medications that affect blood pressure. In that location are some ordinarily used medications that are not unremarkably prescribed for hypertension, but notwithstanding lower BP or increase postural BP changes in many older people.

• Alpha-blockers are a class of medication at present mainly used to help men with benign prostatic hypertrophy urinate. They include tamsulosin, terazosin, doxazosin, and prazosin (brand names Flomax, Hytrin, Cardura, and Minipress, respectively).
• A 2015 report plant that the use of prostate-specific alpha-blockers was associated with a higher chance of fall and fracture in older men.

Medications that lower blood carbohydrate (for people diagnosed with diabetes)

10. Medications that lower blood saccharide. Many older adults with diabetes take medications to keep their blood saccharide from getting as well loftier. Most diabetes medications can cause or worsen hypoglycemia (too low blood sugar).

• For a list of oral and injectable medications used to treat diabetes, see this MayoClinic.org page.
• Metformin (brand proper name Glucophage) is notable in that it causes minimal take chances of hypoglycemia, unless information technology's beingness taken in combination with insulin or other diabetes drugs. Recent enquiry even suggests that metformin might have "antiaging" benefits.
• Research studies have institute that hypoglycemia is associated with falls in older adults.

What to Exercise if Yous or Your Relative Is On These Medications

So what should you do if you lot discover that your older relative — or you yourself — are taking some of these medications?

Well, don't panic. But exercise make certain that you and your healthcare team regularly re-evaluate your need and dosage of these medications.

Hither's what the CDC is telling healthcare providers to exercise about medications linked to falls:

• "STOP medications when possible.
• SWITCH to safer alternatives.
• REDUCE medications to the lowest effective dose."

As a patient or concerned family unit member, it's vital that you lot actively participate in this process with your healthcare providers.

So for every potentially risky medication you are taking, yous'll desire to know:

• What problem is this medication meant to care for or manage? What other options are bachelor to manage this problem? (Don't forget to ask about non-drug treatments!)

• What are the benefits of continuing the medication? What are the likely risks and benefits of discontinuing the medication?

• Is a lower dose of this medication an option? What are the pros and cons of trying a lower dose?

Your health provider should be able to answer these questions for you. But many people find it'due south as well helpful to do a lilliputian research on their ain. I especially recommend learning more than about best practices for managing any health atmospheric condition are currently being treated by the medications in a higher place.

Now, although nearly of the medications above are indeed associated with increased fall gamble, this doesn't mean that information technology'south never appropriate for an older person to exist taking these medications.

Sometimes a careful assessment of the likely benefits and burdens leads patients and their doctors to conclude that continuing a risky medication is, in fact, worthwhile.

But if yous've been concerned about falls for yourself, or for an older loved one, y'all don't want to be using a medication linked to falls unless you and your doctor take thought things through.

And then take a good look at this list, and take a good await at the medications in your medicine chiffonier. Make note of which ones should be discussed with your healthcare team. And then call your clinician and tell them you lot'd like to discuss your need for these medications.

Past taking these steps, you'll be in a much better position to benefit from medication review as part of your fall prevention programme.

Questions about medications and fall chance? Please post them beneath!

[This commodity was last updated in October 2021.]

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Source: https://betterhealthwhileaging.net/preventing-falls-10-types-of-medications-to-review/

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