Fall risks vary with medications, studies find

Older adults are prescribed more medications and are at higher risk of falls, which can cause severe injury, disability and death.

A comprehensive study at the Karolinska Institute in Stockholm looked at data from 64,000 Swedes who were aged at least 65 years and were admitted to the hospital as the result of a fall. Seniors take several drugs with the potential for negative interactions that can trigger a fall.

Of the 20 medications studied, many are already known to present a risk of falls. The researchers’ analysis found that men and women taking opioids and men taking antidepressants were more than twice as likely to experience a fall injury than seniors not taking these medications.

Other medications that were linked to falls were drugs prescribed for ulcers and gastroesophageal reflux disease, vitamin B12 and some nonopioid pain medications. Estrogens and cardiovascular medications were not found to contribute to falls.

The researchers recommend further study to consider the potential for drug interactions, including over-the-counter medications, as contributors to fall risk.

Another study, published in the Journal of General Internal Medicine, looked at medications used to treat high blood pressure (hypertension) and found no relationship between the medications and falls and broken bones. Physicians and their patients worry that the blood pressure medications that are also used to prevent cardiovascular events, such as stroke, might put people at risk of low blood pressure (hypotension), which could lead to falls.

The study, which included people aged 40 to 79 years who had type 2 diabetes, was led by Karen Margolis, MD, of the HealthPartners Institute for Education and Research in the United States.

Participants were all part of ACCORD-BONE, an ancillary study of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) randomized trial, which tested how more intensive treatment of blood glucose, blood pressure and lipids affected cardiovascular disease outcomes in people with diabetes. The average age of the participants was 62 years.

"Lowering blood pressure using intensive treatment compared with standard treatment did not result in an increased rate of falls or fractures and, in fact, showed possible trends towards fewer fractures in the intensively treated patients,” Margolis says. “Although intensive blood pressure treatment to the low levels in ACCORD did not lower cardiovascular events, our results and review of the literature suggest a need to carefully reconsider current thinking about whether antihypertensive treatment and blood pressure lowering increases risk for falls and fractures.”

Results did not vary by age. No evidence suggested that people's risk of falling varied over time, although not enough fractures were studied to determine whether the short-term risk might be higher at the beginning of intensive treatment. Researchers note that subjects in this study were more closely monitored than most patients would be in clinical practice; the results, therefore, may not completely reflect what would happen in actual practice.

Topics: Clinical , Risk Management