How meds influence falls

spiral stairs looking down

New research has shown that older people taking antidepressants or opioids have more than double the risk of a fall and hip fracture compared to those who do not

Writing in Australian Prescriber, lead authors Professor Libby Roughead and Dr Kerrie Westaway from the University of South Australia outline the impact of mind-altering drugs on older people and their contribution to falls.
The side effects of such medicines, including drowsiness, dizziness and blurred vision, are factors which increase the likelihood of falls and fractures, the researchers say.
“Antidepressants, opioids, antiepileptic medicines, benzodiazepines and antipsychotics all increase the risk of hip fractures,” says Prof Roughead.

“Combining them increases the risk even further, up to five times in the case of starting antidepressants and anxiety medicines together.”
This equates to one extra hip fracture for every 17 patients aged 80 years and over who are treated for a year.
“We suggest to prescribers they consider whether patients really need some of their medicines anymore,” Prof Roughead says.

“For example, an SSRI antidepressant may no longer be required if a patient is fully recovered from depression. Similarly, it may be possible to stop an antipsychotic in someone with dementia.

“Doctors should try stopping one medicine at a time, reducing it slowly over weeks or months,” says Prof Roughead.
This risk of falling can be lowered by reducing medicine use, exercising more and using other interventions such as occupational therapy and podiatry, the researchers say.

They also warn that older people may be embarrassed about discussing the risk of falling with health professionals, concerned that this may be seen as a loss of their ability to live independently.

Health professionals should consider asking older patients, at least once a year, if they ever feel unsteady on their feet, or if they have fallen.

They can also advise on preventive strategies, the authors write.

“Patients at high risk of falling include those who are visually impaired, have cognitive impairment, advanced diabetes or a neurological disease.

“Research suggests that multifactorial interventions that include individual assessment, group or home-based exercise programs, and home safety interventions are effective in helping to reduce falls.”

They write that health professionals can explain to older patients that their medicines may be a risk factor which increases their risk of falling, and encourage them to report any dizziness, drowsiness, confusion or blurred vision – and ask them whether they would be willing to consider changes to their medication regime.
The researchers used data from the Australian Government Department of Veterans’ Affairs in a matched case-control study, comparing 8,828 veterans with hip fractures with 35,310 people of the same age and gender, examining their medicine use in the previous six months.

The average age of the cohort was 88 years and 63% were women.

“The risk of hip fracture was increased for all five groups of drugs tested (antidepressants, opioids, antiepileptic drugs, benzodiazepines and antipsychotics). The highest risk, more than double, was when SSRIs or opioids were started and it remained high with ongoing use,” the authors write.

In 2018, an estimated 28,000 Australians over the age of 50 were hospitalised with a hip fracture. Of those, 5% die in hospital and more than 10% are discharged to an aged care facility.

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