Medications Associated with Falls
Polypharmacy is Common
Multimorbidity and the associated use of multiple medicines (polypharmacy) is common in the older population. Medication use among older patients has increased in the past few decades. Several types of medications are associated with an increased fall risk.
Recognizing “fall risk–increasing drugs” is critical in the care of older patients. Most (72%) people aged ≥55 take at least 1 medication, and 20.3% take 4+ medications. Fall risk also increases with the number of drugs used per day, and polypharmacy (the use of ≥3 drugs) is regarded as an important risk factor for falls in older people.
STOP SWITCH REDUCE should be the next step(s) in managing medications that increase fall risk in older patients
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STOP
medications when possible
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SWITCH
to safer alternatives
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REDUCE
medications to the lowest effective dose
Develop a patient plan that includes medication changes and a monitoring plan for potential side effects. Implement other strategies, including nonpharmacologic options to manage conditions, address patient barriers, and reduce fall risk.
Resources
Beers Criteria® (2019 Update)
A compendium of medications potentially to avoid or consider with caution because they often present an unfavorable balance of benefits and harms for older people—plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate. Dr. Mark Beers, a geriatrician, created the first list of potentially inappropriate medications for older adults in 1991 based on expert panel recommendations. In 2012, it became the highly evidence-based document we now rely on. This year’s update is based on a review of 17,627 references and 5403 abstracts since its last update in 2015.
STOPP/START
The STOPP/START Screening tools are based on the STOPP/START prescription criteria, which consist of a set of inappropriate combinations of medicines and disease (STOPP) and a set of recommended treatments for given conditions (START).
STEADI
Stopping Elderly Accidents, Deaths & Injuries. Centers for Disease Control and Prevention
Deprescribing Resource
Canadian Bruyere Research Institute https://deprescribing.org/
This website was developed and is supported by Barbara Farrell, BScPhm, PharmD, FCSHP (Pharmacist) and Cara Tannenbaum, MD MSc (Physician) who work with older people and are concerned about the risks associated with medications in this population and their research teams at the Bruyère Research Institute (Ottawa) and Université de Montréal.