Assistant Professor
Joseph A. Woelfel, PhD, RPh., FASCP, is the Director of Pharmaceutical Care Clinics and...read more
Pharmacology
Medication & Risk Factors That Lead to Falls
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Aging sometimes means reduced balance, coordination, vision, strength and agility. These factors, along with certain medications and even our home environment, can increase our risk of falling.
Ground-level falls are a major health problem for people 65 and older. An estimated 30% of people in this age group fall each year, resulting in hospitalization, permanent disability, and sometimes death. In fact, injuries related to falls are the sixth leading cause of death for seniors, and annual health care costs associated with falls are approximately $10 billion dollars. Once a person has experienced a fall, a “falls cycle” can begin in which the individual experiences an ongoing fear of falling, which can result in decreased activity, loss of strength and mobility, and an increased risk of falling.
Fall Predictors
Being aware of the common risk factors and taking precautions helps lower the overall risk. One or more of the following factors can place a person at a moderate to high risk for a fall:
- Prior fall history
- Poor, uncorrected vision
- Parkinson’s disease, untreated diabetes, and obesity
- Use of medications that can cause drowsiness, dizziness, low blood pressure and weakness
- Use of multiple medications
- Poorly fitting shoes and slippers
- A cluttered, poorly lit home with multiple levels
- Slick or wet floors, throw rugs, electrical or other cords in walk ways
What You Can Do to Reduce Your Risk of Falling
A simple test called “Get-up and Go” can additionally help predict the risk of a fall by determining one’s mobility.2 It’s easy to perform. All you need is a straight-backed chair with armrests. Make sure the chair has a high seat. Then have the individual complete the following steps:
- Rise to a standing position from the chair, using the armrests
- Stand still momentarily
- Walk 10 feet
- Turn slowly
- Walk back to the chair
- Turn around
- Sit down
A successful test occurs if the person completes this in 20 seconds or less. Those passing this test may be considered at low risk when other risk factors are absent.
Medications Associated with Falls
Some medications can place a person at risk for having a fall. This table* identifies some of the most common fall-associated medications. Please note that common brand names are listed, not the generic names. Check with your doctor or pharmacist if you have other fall-related risk factors.
| Sleep Medications (Sedative Hypnotics) Dalmane, Restoril, Nembutal, Seconal |
| Pain Medications Tylenol with Codeine, Vicodin, Lortab, Roxanol |
| Anti-anxiety Medications (Anxiolytics) Xanax, Tranxene, Valium, Ativan, BuSpar, Vistaril, Atarax |
| Anti-allergy Medications (Sedating Antihistamines) Benadryl, Unisom |
| High Blood Pressure Medications Calan, Isoptin, Verelan, Procardia, Adalat, Cardizem, Inderal, Tenormin, Catapres, Capoten, Vasotec, Prinivil, Monopril, Accupril |
| Water Retention Medications (Diuretics) Lasix, Demadex, HydroDiuril, Dyazide, Maxzide, Zaroxolyn |
| Antiseizure Medications (Anticonvulsants) Tegretol, Zarontin, Felbatol, Neurontin, Dilantin, Depakene, Depakote |
| Antidepressant Medications (Tricyclic Antidepressants) Elavil, Norpramin, Sinequan, Tofranil, Pamelor, Vivactil |
| Tranquilizer Medications (Psychotropics) Clozaril, Haldol, Loxitane, Risperdal, Navane, Thorazine, Prolixin, Trilafon, Mellaril, Stelazine, Compazine |
| Alcohol-containing Medications or Beverages Nyquil, cough medicines |
| Overactive Bladder Medications Ditropan, Detrol |
| Gastrointestinal Antispasmodic Medications Bentyl, Levsin, Pro-Banthine, Donnatal, Librax |
How can you reduce your risk of having a fall that might be caused by medication?
- Take your time. Stop for a moment before getting up. Stand slowly to be sure that you have your balance and aren’t light-headed—then walk. This allows your blood pressure to normalize and helps prevent orthostatic hypotension (also known as a head rush or a dizzy spell).
- Use the bathroom before bed. If you are taking a diuretic, schedule your last dose a few hours before going to bed. Also, leave a soft light on that illuminates your pathway to bathroom in case you need to get up during the night.
- Avoid alcoholic beverages in excess.
- Exercise regularly. Exercise strengthens important muscle groups and improves your balance and coordination. Ask your health care provider about the best type of exercise for you.
- Make your home safer. Inspect each room of your home for safety hazards such as poor lighting, obstructed walkways, throw rugs, cords and other obstacles that could cause you to trip. Place regularly used items within reach so you don’t require a ladder or stool. Install anti-slip mats and grab bars in showers and bathtubs.
- Have your vision checked regularly. Get an up-to-date prescription and treat physical conditions such as glaucoma or cataracts that can weaken your vision.
- Get checked for osteoporosis. Ask your doctor or pharmacist about the need for calcium and vitamin D.
Remember: you can prevent falls!
Stay active in both mind and body...take care!
Dr. Joe Woelfel
*Please note that this table is not all-inclusive. Other products can contribute to falls.
1. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994; 331: 821-827.
2. Mathias S, Nayak U, Isaacs B. Balance in the elderly patient: the “Get-up and Go” test. Arch Phys Med Rehab. 1986; 67: 387.
Posted in Home Modification, Home Safety & Fall Prevention, How to Set Up the Home, Nursing Homes, Pharmacology: Dr. Joel Woelfel
A great post. Falls are a serious hazard for frail elderly.
Dr. Woelfel,
thanks for pointing this information out. for someone always concerned and trying to prevent any falls for my mom, this is a great resource. We’ve already had one fall and it’s scary thinking of my mom at home. I’m heading over to check out her med list. i wonder if the drug companies put this information on the warnings section of their inserts?
thanks again!
LadyDar,
The manufacturer’s product insert or product information (PI) as it’s called does have this information in the warning or adverse event section of the brochure. Patients usually don’t receive the PI with their medication; however, PIs are available on the manufacturer’s website. So for example, if you know someone taking Cardural XL then they could visit their site to see what the warning and adverse reactions might be. Be aware that the information could also be listed under the headings of side effects or cautions. However your bottom line should be to always ask your pharmacist to tell you about the common side effects—and you should always specifically ask if a medicine can cause a fall.
Take care,
Dr. Joe Woelfel
very nice article..falls many times begin the downward spiral.