Medication and Fall Prevention

Senior Canadians tend to take more medications as they get older. But do you know how many?  Did you know that the proportion of Canadian seniors age 65 and older who take at least 5 different prescription medications is 66%? This includes Canadians who are living in the community only, and not in long-term care.

The proportion of community seniors taking at least 10 different prescription medications is 27% Finally, community seniors aged 85 and over who take at least 5 different prescription medications is 39%

Researchers have been investigating what happens when we take too many medications. The technical term for taking “too many medications” is polypharmacy—“poly” meaning many, and “pharmacy” meaning, related to medications.

Polypharmacy generally refers to being on more medications than needed, or for which harm outweighs the benefit. The more medications we take, however, the more likely we are to experience drug interactions, falls and fractures, memory problems, or worse, we can get hospitalized or even can die from the harms that can come from taking too many medications.

At our workshops on Medication Awareness, a question that is often asked is, “who is most at risk of experiencing harmful effects of medications?”

The answer is not a simple one, but to start with people with multiple chronic conditions often take many medications in order to manage these conditions. The issue is that when the researchers do the drug trails the people they pick for the trails are young healthy men. The other issue with drug trails is that the researchers only test one drug at a time. Taking many of prescriptions for multiple chronic diseases increases the risk of adverse effects because:

Drug-drug interactions and drug-disease interactions may have unpredictable effects on any another disease a person may have.

Sometimes, additional medications are prescribed to counteract the harmful effects of existing medications, which can exacerbate the problem.

Women are also more likely to be at risk of harms, due to both social and biological factors.

And finally, over the age of 65 (even though 65 isn’t really that old), we begin to become more susceptible to some of the harms or side effects of medications.

Here’s an interesting statistic in the context of Canada: 1 in 200 adults over the age of 65 is hospitalized due to harmful effects of their medication. That’s 5 times higher for seniors than it is for younger people

According to a study done by Canadian researchers released in 2016, Canadians spend $419M per year on medications classified as potentially inappropriate. This figure doesn’t include the cost of hospitalizations due to the harmful effects of these medications.

Canadians also spend $1.4 billion per year in health care costs to treat patients experiencing harmful effects from their medications, including fainting, falls, fractures and hospitalizations.

The risk of falls is also something I talk a lot about as people age. According to the Canadian Deprescribing Network, 1 in 5 people over the age of 65 living in the community report having a fall within the past year. The prevalence of falls is even higher for older seniors (over age 80). For Canadian seniors, most hospitalizations from injuries are due to falls.

What most people don’t realize is that some medications can make you more likely to fall. As you can see from the following chart, sleeping pills increase the risk of falls by 47-57%. Antipsychotics often given to people with dementia, increase the risk of falls by, even more, 59%. Falls for seniors can be life-threatening and are something to be unconcerned about. Twenty to thirty percent of hip fracture patients die within one year of fracture? And that 95% of hip fractures occur during a fall?

There are a number of ways to prevent falls in our age group. First, don't be nervous or shy about talking to your physician about factors that may increase the risk of falling. Tell your doctor if you have fallen. Many falls go unreported but we know that one fall often is a prediction of others. It is important to stay mobile and to use assistance if it is needed. 

Other steps you can take to  prevent falling are:

Strengthen your muscles: exercise to strengthen your muscles, especially your legs, and improve your balance. There are many programs or activities that will help you achieve this. The recommended exercise prescription to prevent falls is at least 30 minutes per day.

Optimize your eyesight: have your vision assessed regularly by an optometrist. Correct problems (myopia, presbyopia, cataracts, etc.) as needed. Cataract surgery can reduce the risk of falls by up to 37%.

Create a safe environment: limit carpets that slide easily over floors and over which you may slip and fall, remove furniture that obstructs passageways, use adequate lighting. A safe environment can reduce the risk of falls by up to 20%

Stop medications that may increase the chance of falls: return prescriptions to the pharmacy that cause falls can reduce the chance of falls by approximately 25%.

Do not stop any medication without talking to your doctor or pharmacist.

                                         Drugs that increase the risk of Falling in Seniors