Sedatives and Mood Altering Drugs Related to Senior Falls

A major new study, led by a University of British Columbia expert in pharmaceutical outcomes, confirms that falls among elderly people are significantly associated with several types of drugs. On top of the list are sedatives often prescribed as sleep aids, and some medications used to treat depression.

The new study, published in a recent issue of the Archives of Internal Medicine, provides the latest evidence of the impact of certain classes of medication on falling among seniors. Falling and fall-related complications such as hip fractures are the fifth leading cause of death in the developed world, the study noted.

Antidepressants showed the strongest statistical association with falling, possibly because older drugs in this class have significant sedative properties. Drugs often used to treat schizophrenia and other psychoses, and benzodiazepines such as valium were also significantly associated with falls.

"These findings reinforce the need for judicious use of medications in elderly people at risk of falling," says principal investigator Carlo Marra, a UBC associate professor of Pharmaceutical Sciences. "Safer alternatives, such as counseling, shorter-term or less-sedating therapies, may be more appropriate for certain conditions."

The UBC study examined the effects of nine classes of drugs. It updated, expanded and analyzed 22 international observational studies investigating falls among people aged 60 years or older. The analysis included data on more than 79,000 participants and both prescription and over-the-counter medications. 

The study looked at medication classes including anti-hypertensives (used to reduce blood pressure); diuretics; beta-blockers used to treat heart conditions; and non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen. "Elderly people may be more sensitive to drugs' effects and less efficient at metabolizing medications, leading to adverse events, which in turn lead to falls," says Marra. 

Prescribing medications to seniors has increased substantially over the past decade, according to the study. For example, UBC research shows that more than one in seven people aged 80 or older filled at least one antidepressant prescription in 2006. In addition, determining which medication classes are associated with falls remains a challenge, since seniors are often on multiple medications for multiple health conditions, with new drugs entering the market on a regular basis. 

In follow-up research, Marra aims to explore how pharmacists can identify patients at risk of falling and educate them about medication use to ensure their safety. 

Source: University of British Columbia. Research was supported in part by the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research.

Learn how in-home care can help seniors manage their medications! See "Senior Medication Problems: Home Care Can Help" in the July 2009 issue of Choices.