Study: 94% of older adults prescribed drugs that raise risk of falling

by Marcene Robinson, University at Buffalo

Credit: CC0 Public Domain

Nearly every older adult was prescribed a prescription drug that increased their risk of falling in 2017, according to new University at Buffalo research.

20 mar 2021--The study found that the percentage of adults 65 and older who were prescribed a fall- risk-increasing drug climbed to 94% in 2017, a significant leap from 57% in 1999. The research also revealed that the rate of death caused by falls in older adults more than doubled during the same time period.

Even minor falls may be dangerous for older adults. Falls that are not fatal can still result in injuries—such as hip fractures and head traumas—that may drastically lower remaining quality of life. Each year, nearly $50 billion is spent on medical costs related to fall injuries among older adults, according to the Centers for Disease Control and Prevention.

The alarming results solidify the importance of interventions to de-prescribe potentially inappropriate drugs among older, frailer patients, says Amy Shaver, PharmD, lead investigator and postdoctoral associate in the UB School of Public Health and Health Professions.

"Our study indicates two trends increasing concurrently at a population level that should be examined at the individual level. Our hope is it will start more conversations on health care teams about the pros and cons of medications prescribed for vulnerable populations," says Shaver.

Additional investigators in the UB School of Pharmacy and Pharmaceutical Sciences include Collin Clark, PharmD, clinical assistant professor; David Jacobs, PharmD, Ph.D., assistant professor; Robert Wahler Jr., PharmD, clinical associate professor; and Mary Hejna, PharmD, pharmacy resident at Kaleida Health.

Recently published in Pharmacoepidemiology and Drug Safety, the study examined data on deaths due to falls and prescription fills among people 65 and older from the National Vital Statistics System and the Medical Expenditure Panel Survey.

Fall-risk-increasing drugs include antidepressants, anticonvulsants, antipsychotics, antihypertensives (for high blood pressure), opioids, sedative hypnotics, and benzodiazepines (tranquilizers such as Valium and Xanax), as well as other nonprescription medications.

From 1999-2017, more than 7.8 billion fall-risk-increasing drug orders were filled by older adults in the United States. The majority of the prescriptions were for antihypertensives. However, there was also a sharp rise in the use of antidepressants, from 12 million prescriptions in 1999 to more than 52 million in 2017.

"The rise in the use of antidepressant medications seen in this study is likely related to the use of these agents as safer alternatives to older medications for conditions such as depression and anxiety," says Shaver. "However, it is important to note that these medications are still associated with increased risks of falls and fractures among older adults."

Women were also found more likely than men to be prescribed fall-risk-increasing drugs, particularly Black women, who received the medications at the highest rate compared to women of other races. White women who were 85 and older experienced the largest increase in deaths from falls, rising 160% between 1999 and 2017.

The investigators are involved in multidisciplinary de-prescribing initiatives conducted through Team Alice and the UB Center for Successful Aging. The efforts encourage and evaluate patient/caregiver-initiated de-prescribing conversations with health care providers, promote interprofessional education on de-prescribing, and advocate for policy and system changes.

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More information: Amy L. Shaver et al, Trends in fall‐related mortality and fall risk increasing drugs among older individuals in the United States,1999–2017, Pharmacoepidemiology and Drug Safety (2021). DOI: 10.1002/pds.5201

Journal information: Pharmacoepidemiology and Drug Safety 

Balance and strength training can prevent falls in older people

Balance and strength training is known to reduce falls in older adults. However, less than 10% of older people routinely engage in strength training and it is likely that this is much lower for activities that challenge balance.

08 aug 2012--It has been suggested that integrating exercise into everyday activities may help people stick to it, but this approach has never been investigated in frail older people at risk of falls.

So a team of researchers at the University of Sydney designed and tested the Lifestyle integrated Functional Exercise (LiFE) programme, which involves embedding balance and lower limb strength training into daily routines, such as walking, stepping over objects and moving from sitting to standing.

They then compared this approach with a structured exercise programme (performed three times a week using ankle cuff weights) and gentle 'sham' exercises that acted as the study control.

They recruited 317 men and women aged 70 or older, living in the community and having two or more falls, or one injurious fall, in the past year.

Participants were split into the three treatment arms and recorded any falls over 12 months using daily calendars. Other measures like static and dynamic balance, ankle, knee and hip strength, daily living activities, and quality of life were also measured recognised scales.

They found a significant (31%) reduction in the rate of falls for participants in the LiFE programme compared with the control group. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group.

There was a non-significant reduction in the rate of falls for participants in the structured programme compared to the control group.

Compared with control patients, LiFE participants showed improvements in both static and dynamic balance, ankle strength, and in function and participation in daily life, suggesting that this programme improves both fall risk and frailty.

Adherence was significantly better in the LiFE programme and control group compared with the structured exercise programme.

The authors conclude that the LiFE programme "provides an alternative to traditional exercise for older people to reduce falls, to improve function in doing activities and to enhance participation in daily life."

In an accompanying editorial, Professor Meg Morris from the University of Melbourne says that for fall prevention programmes in older people to be effective, "therapeutic exercises, education, and physical activities need to be sustainable, enjoyable, and effective over the long term."

She adds: "The belief that falls should be accepted and tolerated as part of the ageing process is a myth that needs dispelling. Many falls can and should be prevented."

More information: 
www.bmj.com/cgi/do… 36/bmj.e4547 
www.bmj.com/cgi/do… 36/bmj.e4919

Provided by British Medical Journal

Study: 21 percent of newly admitted nursing home residents sustain a fall during their stay

One in five short-stay nursing home patients sustains a fall after their admission, and certified nursing assistant (CNA) staffing is associated with decreased fall risk, according to a study in the Journal of the American Geriatrics Society.

21 jun 2012--Researchers from the University of Southern California and Brown University analyzed the 2006 Minimum Data Set (MDS) assessments of all Medicare/Medicaid patients admitted to a nursing home for the first time. Among more than 230,000 patients in nearly 10,000 nursing homes across the country, the researchers found that 21% of newly admitted nursing home residents sustained at least one fall during their first 30 days in the facility.
To identify potential factors contributing to falls, the study also examined various organizational characteristics of nursing homes. Facilities with higher CNA-to-patient staffing ratios were associated with fewer falls, likely because CNAs provide much of the hands-on patient care during high-risk activities such as toileting, dressing, and ambulation.
While fall rates among long-term nursing home populations are well documented, the nationwide study is believed to be the first of its kind to specifically analyze fall rates among newly admitted nursing home residents. Because newly admitted nursing home residents are in a novel environment and are unfamiliar to staff, identification and management of fall risk poses a particular challenge.
Lead author Natalie Leland, a research gerontologist and occupational therapist at the University of Southern California, explains how this study highlights the unique health care goals of a rehabilitating population striving to get back to the community relative to those of long-term patients who reside in the nursing home.
"A fall can delay or permanently prevent the patient from returning to the community, and identifying risk of falling is essential for implementing fall prevention strategies and facilitating successful discharge back to the community."

Provided by University of Southern California

Irregular Medication Use Puts Seniors At Risk For Falling

23 may 2010--Older adults increase their chances of falling by not taking their medications as directed, according to an article in the latest edition of the Journals of Gerontology Series A: Biological and Medical Sciences (Volume 65A, Number 5). This new information comes from a recent study of Boston-area residents over age 70, which found that those who sometimes neglected their medications experienced a 50 percent increased rate of falls compared with those who did not.

"Falls can now be added to the growing list of poor health outcomes associated with non-adherence to medication," said lead author Sarah D. Berry, MD, MPH, a research scientist with the Institute for Aging Research at Hebrew SeniorLife in Boston. "Because non-adherence is common and easy to screen for, health care providers should discuss this subject with their patients."

Berry and her co-authors are the first investigators to study the association between falls and medication adherence. The team used data gathered from subjects in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston (MOBILIZE Boston) Study, a community-based cohort of seniors recruited for the purpose of studying novel risk factors for falls. They examined responses from a total of 246 men and 408 women with an average age of 78. Between 2005 and 2008, 376 individuals in this group reported a total of 1,052 falls.

A participant was characterized as having low medication adherence if he or she answered yes to any of the following questions: Do you ever forget to take your medications? Are you careless at times about taking your medications? When you feel better do you sometimes stop taking your medications? Sometimes if you feel worse when taking your medication, do you stop taking it? High adherence was defined as a "no" answer to every question. In total, 48 percent of the respondents were classified as having low medication adherence.

Those in the low-adherence group experienced falls at an annual rate of 1.5 times that of the high adherence group. This association persisted after adjusting for other variables, including age, sex, cognitive function, and total number of medications.

The journal article's authors were supported by the Hartford Geriatrics Health Outcomes Research Scholars Awards Program, the Hebrew Rehabilitation Center for the Aged/Harvard Research Nursing Home Program funded by the National Institutes of Health, and an unrestricted grant from Pfizer, Inc.

Source:
Todd Kluss
The Gerontological Society of America

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Emotional stress may raise older adults' fall risk

By Amy Norton

NEW YORK, 28 feb 2009– While physical frailty puts elderly adults at risk of falls and bone fractures, emotional distress can be the immediate trigger of some of those accidents, new research suggests.

In a study of older adults hospitalized for fall-related hip fractures, Swedish researchers found that the patients' odds of suffering a fall were elevated for up to one hour after an emotionally upsetting event.

The risk rose by 12-fold following a bout of anger, and by 20 times after a generally stressful incident. Meanwhile, sadness was linked to a nearly 6-fold increase in the risk of a fall-related fracture, the researchers report in the online journal BMC Geriatrics.

The study cannot reveal why emotional distress might contribute to falls. But one possibility is that it distracts elderly adults' attention away from maintaining their posture and balance, according to Dr. Jette Moller and colleagues at the Karolinska Institute in Stockholm.

Stress might also interfere with older adults' visual focus, another key to maintaining balance and preventing falls.

"We think it is good if elderly adults are aware that emotional stress might interfere with (their) attention while walking, standing or while changing posture," Moller told Reuters Health.

Emotional stress may not be avoidable, she noted, but people can alter their reactions to it. When emotions are running high, older adults might be better off sitting down until the stress has passed, Moller suggested.

That could be especially important for people at high risk of falling due to physical impairments or poor vision, the researcher added.

The study involved 137 patients age 65 and older who were treated for a fall-related hip fracture at one of two hospitals. Nurses interviewed each patient about the injury and the activities they'd been involved in over the two days prior to the accident.

They also asked the patients whether and when they'd had any feelings of anger, sadness, worry, anxiety or stress during that time.

While most patients did not report any emotional stress shortly before their fall, episodes of anger, stress or sadness did appear to precipitate falls in a small number of patients.

This appears to be the first study to find a link between emotional distress and falls, according to Moller's team. More studies, the researchers say, are needed to confirm the findings, and to uncover the reasons for the connection.

SOURCE: BMC Geriatrics, online February 9, 2009.

AUA: Urinary Symptoms in Older Men Linked to Increased Fall Risk

By Charles Bankhead

ORLANDO, 23 may 2008-- Lower urinary tract symptoms significantly increase the risk of falls in older men, a large prospective cohort study suggested.
Both moderate and severe symptoms independently influenced the risk of falls, J. Kellogg Parsons, M.D., of the University of California San Diego, reported at the American Urological Association meeting here. Falls were most closely associated with urgency, straining to start urination, and nocturia.
"These results may justify routine assessment of urinary symptoms in primary care," Dr. Parsons concluded.
Lower urinary tract symptoms affect 15% to 60% of men age 40 and older, and the prevalence increases with age. Falls also become more prevalent with age, and 25% of men older than 65 have one or more falls each year, Dr. Parsons noted.
Symptoms, particularly nocturia and incontinence, have been postulated to increase the risk of falls, but the association had not been studied in detail, he continued. The Osteoporotic Fractures in Men (MrOS) study afforded a chance to examine the link between LUTS and falls in a large group of community-dwelling men.
Dr. Parsons and colleagues analyzed data on 5,872 MrOS participants, all 65 or older. Baseline information included the prevalence of lower urinary tract symptoms, as defined by the AUA Symptom Index: mild, 0-7; moderate, 8-19; and severe, 20+. Stratification by symptom score showed that 54% of the men had mild symptoms, 39% had moderate symptoms, and 7% severe.
Overall, 1,231 men (21%) reported falling at least once in the previous 12 months. The risk of falls increased significantly with age (P<0.0001)>