Researchers at the University of North Carolina have published a lengthy list of prescription drugs that increase the risk of falling among older patients.
Falls are the leading cause of both fatal and nonfatal injuries in adults 65 and older. An estimated 300,000 hip fractures occur each year, often as a result of falling. Head injury is also a problem among adults who fall.
Adults who take four or more medications at a time are at highest risk for falling. But certain types of drugs can also make someone more prone to falling, said Susan Blalock, an associate professor at the U.N.C. Eshelman School of Pharmacy.
The medications on the list cover a wide range of common prescription seizure medications and painkillers, among others. Also on the list are popular antidepressants like Celexa, Effexor, Wellbutrin, Prozac and others.
Researchers said the “common denominator” among the drugs on the list is that they all work to depress the central nervous system, which makes patients less alert and slower to react. The list was published in the June issue of The American Journal of Geriatric Pharmacotherapy.
Stefanie Ferreri, the lead author of the paper and a clinical assistant professor in the pharmacy school, said that patients need to be wary of more than just prescription medications, because many over-the-counter medications can also contribute to falls.
“Some allergy medications, sleep aids and some cold and cough remedies can have the same effects as prescription drugs,” Dr. Ferreri said. “Anything that can cause drowsiness can put you at increased risk of falling.”
The researchers warned that if patients see a drug they are taking on the list, they should not stop taking it. Many drugs can trigger serious side effects if stopped abruptly. But patients should talk to their doctors about falling risk and possible alternative medications, the researchers said.
Physicians should look for medications that have been proven safe and effective in older adults and look for medicines that have less of a sedating effect. Physicians should be especially wary of anticholinergics, a class of drugs that affect nerve cells used to treat a wide range of conditions.
To download the complete list of the prescription medications that increase the risk of falls, click here.
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Interesting research.
I have worked with groups of individuals who suffer from depression for the last few years.
It is a project where we use a structured fitness program as an exercise prescription for depression.
Some of the participants are on anti-depressants, while others are not (BTW, the ones NOT on the drugs do better with the exercise program).
I have found that the participants who are NOT on the drugs, are able to progress from very stable exercises to movements where balance and co-ordination are being challenged at a much faster rate. They just seem to ‘get it’ quicker than the others.
Maybe this is why. I am going to have to check out the details of the study.
Thanks for the heads up Tara.
p.s. I loved yesterday’s post. The comments were unbelievable. I was very impressed that you could keep up with them - 500 comments - wow
On a related topic, my post on UK politician David Cameron and his comments on obesity and personal responsibility received some interesting comments as well. Not 500 comments, but then again, I don’t have your audience.
http://healthhabits.wordpress.com/2008/07/08/youre-fat-its-your-fault/
With your NYT clout, perhaps you would be able to interview him for a future post.
FROM TPP — Your anecdotal experience with the exercise program, and the fact that non Rx drug users do better, is interesting. As for David Cameron — thanks for the link. I was interested to learn more about him but I see he’s just a career politician with a business background in communications. I just don’t ‘think he has the credentials to talk about this issue with any authority. What does he really know about obesity and health? Of course he’s entitled to his opinion, as are all the readers of this blog, but I don’t think he has any more knowledge of the issue than the average person. Now if he was the surgeon general or ran the UK National Health Service — and his views had an impact — that would be interesting. But he’s just an MP trying to make headlines and get on the news (in my opinion.) Interesting though. thanks.
— DRWhat was the point of this, to scare us, sell newspapers and make the researchers look good. The ones I take that are on the list have big warnings of the side effects.
We already have enough people quitting drugs they should be taking because of articles and research like this. All medicines have side effects and the trade offs must be evaluated with your doctor before you start. There are usually other drugs of the same class that can be taken without deleterious side effects.
— RichI agree with you that his expertise on this subject is no greater than any other layperson and that his comments were undoubtedly made for political gain. Even bad publicity is good publicity for a politician?
What I find interesting about his outburst is that it highlights how political obesity and the obese have become. He also discussed crime, alcoholism and drug addiction in his press release, but everyone in the UK is focusing on the obesity angle.
Obesity seems to becoming an ‘ism’ topic like racism or sexism.
— DRHow did we get from falling because of polypharmacy to good old fat again? Pretty neat trick. I looked at that Cameron’s spew. More ignorant, biased, judgmental garbage, in my view. We seem to have no shortage.
— StarThank you for posting this. Looking through this list I do not see my blood pressure pills mentioned, however many seniors I know have had falls and I know for certain some of these individuals were taking drugs from this list. I do not look upon the article as a scare tactic but as caution to be aware and to watch out for oneself. We are all adults should be able to face reality. We need to discuss these alleged effects with our Doctor.
— elizabethFull disclosure, retired M.D. Basically any sedative makes one slower by definition. We move more slowly, think more slowly, react more slowly. The unsaid reality is that ALCOHOL is probably a bigger culprit than any of the laundry list of sedatives and anti-depressants. I’m surprised that some of the anti-hypertensive drugs are not included. The delay in the blood pressure response to standing up from a sitting or lieing position(postural hypotension) can result in many falls also. The admontion should be to make sure the drugs are necessary and to otherwise BE CAREFUL. And for those who are unable to lok out for themselves provide necessary supervision.
— Bob TichellIn addition, I think someone (maybe a citizen) should sit media-gluttons like Cameron down and have a serious talk about their need to denigrate and judge and try to make others “face” their situations. Maybe if they kept a diary of every time they felt like judging that would help. Maybe therapy. Maybe pushing away from the microphone or going on a journalist fast. It’s difficult–but others have done it and stayed off being annoying twits for months or even years.
— StarYour article is misleading and poorly researched.
The publication in the American Journal of Geriatric Pharmacotherapy by Stefanie Ferreri and co-workers is titled “Methodology of an Ongoing, Randomized Controlled Trial to Prevent Falls Through Enhanced Pharmaceutical Care”. This article, as its title indicates, is about a Methodology.
The list of drugs, in the article, (and the one you have linked), was NOT an outcome of the methodology. In fact, it is NOT the outcome of any study. It is the outcome of a literature review by 2 pharmacists.
The list should be taken with a bucketload of salt -maybe 2 bucketloads to be safe, - till results of the study (which is still ongoing) are published!
— VSFROM TPP — Well perhaps you disagree with the researchers, but the post very specifically says (in the first sentence no less) that this is a story about a list of drugs compiled by these researchers.
Great article, and I did not find it one designed to sell newspapers and make researchers look good. I recently had a hip replaced and my doctor told me in a good-natured way that I am “not allowed to fall.” I live in the woods, recreate in the wood and do fall on occasion. In fact I think I recently read an AARP item that said one in three or four older Americans can expect to fall in any given year and that a considerable percentage of those will have their mobility restricted in some way do to the fall. I am on one of the drugs in the list and had the amount increased some time back. I noticed an subtle increase in “close calls” in falling and never associated the increase to the drug, and I was not advised to that possibility. Your article alerted me to that possibility. Good job…good journalism…and keep up the good work.
— paulThis is very helpful, thank you.
I wondered for years why my mother had fallen. She said, “I fell off the sofa.” It led to a series of health problems, and eventually, not being able to live on her own, and eventually, she passed away.
I realize now - she was taking multiple prescriptions. Presumably, as you wrote, she got up and - fell before standing up. That’s why she said she fell from the sofa.
Thanks for clearing this up.
Here in England, there is not as much info as easily available.
Carole
— Carolehttp://www.Americans-Away-From-Home.com
I was a dancer….I have been taking klonopin for years….For anxiety since a divorce…..I fell two weeks ago………………..Tripping on the street walking not realizing that the street was elevated from tree roots…Luckily I didnt break my wrist….I have also put on weight as the meds slow my metabolism down…Now I cant sleep without medication and will probably have to go to drug rehab….Its a worry since I will be sixty…Thanks..
— rachaelVery interesting…and no, Rich it isn’t scary - it’s called INFORMATION.
I notice there aren’t any blood pressure lowering drugs listed that can sometimes cause situational dizziness, so I don’t think this is an all-inclusive list.
— C. ReavesVery nice article. I can’t wait for the next one; the one that gives the list of drugs that I can switch to.
— Lois FeronMirapex can be a *very* dangerous drug, and should be added to the list. My mother-in-law took Mirapex for a year or so to treat restless leg syndrome. She started to suddenly fall asleep - sometimes while sitting, sometimes while standing - which resulted in many falls. It’s a miracle that there was no serious injury.
I did a little research on the meds that she was taking. It turns out that “sleep attacks” are a known issue with Mirapex, and have resulted in some number of car crashes among other things. This is enough of a problem that the manufacturer had to send warning letters out to prescribing docs.
My mother-in-law stopped the Mirapex, and the sleep attacks stopped right away.
Docs should really warn patients of this problem when prescribing!
— Manny GoldsteinVery good. I recently had exactly that problem (plus two others) with diazepam Quite seriously, too. I take flurazepam occasionally and codeine very infrequently but have not had the problem. It appears to me that continuous use over a period of several days or more is required. My age is close to 80.
See also http://www.dcri.duke.edu/ccge/curtis/beers.html
— JohnTwo of the drugs on the list I take and falling is a risk for me. How I manage my risk is by while I am motionless but just before I go into motion, I think to myself conscious thought then conscious effort and then go into motion. It certainly slows me down but it keeps me safe.
— Ruth BeazerRuth Beazer
I am chatty today–sorry. Since weight got dragged into this one, I see a slight connection. Larger people may be less flexible and nimble and may fall more easily without drugs, even. But–I believe I am right on this–larger women are less likely to suffer from osteoporosis, so if they fall, they are more likely to bounce. All that fat holds estrogen, which keeps bones from getting brittle. If I am all wet on this, just tell me. I have been told this, though.
FROM TPP — You are correct. Being overweight is associated with lower risk for fractures and osteoporosis.
— StarOur medical industry, funded and controlled by BigPharm, is a disgrace. I live in South Florida where far too many older patients are taking 20 or more pills a day. The idea that we can change the body’s chemistry to that extent, and monitor it closely enough to avoid problems is delusional. When Hospice gets involved (they are true heroes), they wean these patients from many of the drugs and, more often than not improve their condition. We will look back at this era of expensive and foolhardy medicine as barbaric and greedy. Shame.
— gershon levittMy hypertensive drug makes it likely I will fall. I’m drowsy, and everything seems to slow down - (like I feel when I’ve had a drink). I used to fall sometimes because I was multi-tasking, trying to get something done ASAP. But I take things slower now.
— Help me I’m FallingIn relation to medications, I have been told that one of the key issues is coordination of multiple medications and treatments in re side effects and interactions. So this fits together with the material in the article to foster a consistent picture of at least one part of the risk for falls.
On another note, I would second the M.D.’s comments about alcohol and falling. (Full disclosure: I am a not-retired Ph.D. in psychology and human factors.) In the early 1980s I accepted a role as an expert witness for the defense in a slip and fall incident leading to potential liability for a ankle injury. As part of my preparation, I obtained a copy of the record of admissions to a British emergency ward for falls. I had no particular expectations, and was stunned to find that more than 90% of the cases involved alcohol. This turned out to be predictive in the litigation. I never had to take the stand, because I worked out the physics of the reported fall, and determined that it could not have happened as complainant asserted. Thus, during complainant’s testimony, the defense attorney went through the details, and obtained an admission that the party had been drinking. Plaintiff was under the influence, was bumped inadvertently, and fell. Case dismissed. So this fits with the emerging theory that risk is increased by substances that dull the mind’s ability to pay attention, shift attention, understand the meaning of what it notices, and translate that into appropriate physical action.
Looking carefully at my own ability to avoid falls, I see that the difference between falling and not falling can be a very fine line involving, as well, the ability of various parts of my body to make very rapid adjustments. The message about the costs of falling can take a long time to get through a thick skull, too. Skinned palms are one thing remembered from childhood. However, for me it was a fall on an icy hill while cross country skiing the winter before last that got the message through. My hip survived the primary impact without complaint. However, my shoulder took six months to recover from an injury that I did not notice until after I had gone out skiing again a few days later. So this introduces another dimension: To what extent do various medications make it more difficult for us to “get it,” to pay attention, to remember our experiences, and to re-appraise our personal realities about the risks involved with falls.
— John Carlton-Foss, Ph.D.This is in response to Rich: It would be reasonable to think that doctors would be aware of side effects and discuss them fully with patients and that if there were problems, the doctors would make a strong effort to solve the problems. In my experience (admittedly limited) with my parents and in-laws, many doctors are unaware of or choose to ignore side effects of drugs and instead of tinkering with med levels, they prescribe more drugs to treat the new symptoms, and the new drugs end up interacting negatively with the old drugs. Overmedication seems to be a big problem for the elderly.
— MegI’d like to add that I don’t blame doctors for falls; I think we all need to be aware of the many possible causes and dangers of falling. My mother has had serious falls twice in the past five years. Neither was related to medication; both involved ice. The first time, she hit her head and ended up with a subdural hematoma, which required surgery several weeks later after her legs started getting numb. The second time, she also hit her head but, fortunately, suffered only temporary memory loss and a sore head. My father fell off the table in the emergency room (while he was unattended after having a stroke) and got a huge shiner. I have twice been pulled down when I was walking the dog. The first time, I hit my head and suffered the worst pain I have ever felt (that includes childbirth); the second time, I hit my chest and probably broke a rib.
— Megdon’t kill yourself. But medicine isn’t always the way to go. Try a different diet, or try to have fun. Dance, watch some hi-larious videos on YouTube
— dontkillyourselfI cannot find the original article to read, but would like to know how they determined that all of these drugs increase risk of falling. I doubt any large controlled trials, such as are required to show efficacy, have been done to assess falls. Many of the listed drugs are sedatives which can be assumed to increase risk, and many are obsolete drugs that no one uses. Wellbutrin and most SSRI antidepressants are not brain depressants and I’m not aware they are implicated in falls. I doubt digoxin has any connection with falls although the underlying cardiac conditions for which it is prescribed may be responsible. People on multiple drugs have multiple medical problems which may restrict physical activity and lead to falls.
My observation is that most pharmacists are too busy to spend much time talking to patients and derive their knowledge of side effects from the literature rather from the real world. The typical advice to a patient picking up a prescription is often a preprinted sheet listing numerous side effects without regard to the relative frequency of side effects, or whether there is any causal relation to the drug. Listing upper respiratory infection as a side effect of a drug is worse than useless. Prescribing any drug is a risk-benefit calculation, hard to do if side effects are exaggerated or misrepresented.
Ohio MD
— Roger Mansnerus, M.D.Every person needs to be viewed as an individual. For instance, I noticed that several sleeping pills are on that list. But being chronically sleep=deprived also makes one prone to accidents.
Maybe anti-depressants make people clumsy. Personally I haven’t spotted it. I have a dear friend on antidepressants, and she is very well-coordinated. However, the risk of a fall from antidepressants has to be weighed against the quality of life when one lives with chronic and unremitting depression. I’d like to know if the people who put out this list, which sounds extremely scary, actually have research tying falls to all those drugs.
This whole area seems to be a giant rant against pharmaceuticals. They really aren’t all evil.
— Gail Perry