Falls and Polypharmacy in the Elderly: The statistics continue to trend upward as our Senior population grows, yet we still don't have a handle around de-prescribing medications.

As I posted yesterday, polypharmacy is a significant concern in our elderly population for multiple reasons, the most important being their personal safety. The more medications a person takes, the higher the risk for poor outcomes and hospitalizations. We do not do a good job in practice addressing these long medication lists. We need to do better. Before you see your next patient in clinic for an annual wellness visit appointment, step back and think about the medication list.

(I wrote this post for my LinkedIn profile to share with primary care providers. Although it is not written speaking to the patient population, I decided to post it here as well, as there is some valuable material for patients as well.)

• Is there still an active indication for each medication your patient is taking?

• Is your patient taking any high risk medications? Glance over the Beer's Criteria.

• If your patient is taking high risk medications, does a safer alternative option exist?

• Is your patient over the age of 75? If so, updated guidelines suggest stopping primary prevention agents, such as aspirin and statins IF they do not have a personal history of coronary artery disease or infarction, cerebral vascular disease/stroke or peripheral arterial disease. Discussion should be had with the patient regarding their wishes to continue for primary prevention or stop.

• What symptom complaints does your patient have? Could symptoms be related to medication side effects?

• The more medications a patient is prescribed, the more likely, and the more often, they miss doses of the more important agents. Can you stop minimally beneficial medications in order to increase compliance for the most important medications?

• How are they doing financially? Can they afford all of their medications?

Some Interesting Statistics

• Prevalence of Polypharmacy: Approximately 40% of older adults (aged 65 and older) take five or more medications. The patients I see in practice, that have a short term rehab, or TCU stay, are very rarely on less than 10 medications.

• Falls Incidence: About 30% of older adults experience falls each year, with the incidence increasing with age. Falls can result in fractures. A large subset of this population, especially females, have osteoporosis, so are already at increased risk for fractures.

• Medication-Related Falls: Studies indicate that polypharmacy is linked to a 1.5 to 2 times higher risk of falls compared to those taking fewer medications. Also, the more medications a person is taking, the fall risk increases.

• Specific Medications: Certain classes of medications, such as sedatives, antidepressants, and antihypertensives, have been found to significantly increase fall risk. This in not only prescription medications. It's very common to see patients taking over the counter sleep aids such as Tylenol PM, or Advil PM that contain benadryl. Benadryl which is highly anticholinergic, can cause falls and cognitive impairment in those 65 years old and older.

• Hospitalization Rates: Falls are responsible for over 800,000 hospitalizations annually in the United States, with polypharmacy being a contributing factor. Do that math!

• Mortality Rates: Falls are the leading cause of injury-related deaths among older adults, with polypharmacy contributing to the severity of these incidents.

  
  

How does this happen?

• Medication side effects (dizziness, lightheadedness, sedation, balance issues, the list goes on).

• Drug interactions that impair balance or cognition amongst other issues.

• Inadequate medication management and oversight.

• Incorrect medication lists during multiple out of system specialty appointments, or lack of medication reconciliation after hospitalizations. Sometimes hospitalizations are in another system, which complicates accurate medications lists even further.

• Comorbidities requiring complex medication regimens.

  
  

Prevention Strategies

• Regular medication reviews by healthcare professionals

• Implementing fall risk assessments in clinical settings

• Encouraging non-pharmacological interventions for managing symptoms before medication prescribing when possible.

• Educating patients and caregivers about the risks of polypharmacy

  
  

Understanding the relationship between polypharmacy and falls in the elderly is crucial for developing effective prevention strategies. Reducing the number of medications and ensuring proper management can significantly lower the risk of falls and improve overall health outcomes for older adults. Most importantly, it can increase their quality of life.

Thanks for reading!