Are You at Risk for a Fall?

Falls Happen More Often Than You Think

Every year there are millions of falls occurring in the older population, aged 65 and older.² About 1 out of 4 older people fall each year, with less than half reporting it to their doctor.² Your chances of a recurrent fall doubles after your first fall. The emergency department (ED) treats about 3 million older individuals for fall injuries each year.² The most common injuries seen in the ED after a fall includes fractures, superficial injuries, and head injuries.^(2,3) Patients have reported a reduction in their quality of life up to 9 months after being admitted in the ED for a fall.³

After a fall you may develop a fear of falling. This can cause negative health effects including:³

• Recurrent falls
• Reduced physical activity
• Restriction or avoidance of social activities
• Depression/anxiety

Are You at Risk for a Fall?

Here are a few questions to help you determine if you are at risk of a fall:⁵

• Do you rush to use the bathroom?
• Do you take a medication to help you sleep or improve your mood?
• Do you take a medication that sometimes makes you feel light-headed or more tired than usual?
• Do you use or have been advised to use a cane or walker?
• Have you lost some feeling in your feet?
• Do you feel unsteady when walking at times?
• Have you had a previous fall?

Answering yes to any of these questions should warrant a conversation with your doctor about getting screened for your risk of falling.

There are certain chronic medical conditions that can contribute to your chances of a fall such as arthritis, dementia, stroke, cataracts, Parkinson’s disease, and urinary incontinence.¹ Some of the medications used for these health conditions can increase your risk of a fall. However, falls can be caused by almost any medication that effects your brain or blood circulation.

Some Medications Can Increase the Risk of a Fall

A few medications that can increase your risk of a fall include:³

• Antihypertensive agents (ex: Lisinopril, Enalapril, Doxazosin)
• Diuretics (ex: Metolazone, Furosemide)
• Beta blockers (ex: Atenolol, Metoprolol)
• Sedatives and hypnotics (ex: Zolpidem, Zopiclone)
• Neuroleptics/Antipsychotics (ex: Quetiapine, Olanzapine, Risperidone)
• Antidepressants (ex: Sertraline, Duloxetine, Venlafaxine)
• Benzodiazepines (ex: Temazepam, Lorazepam, Diazepam)
• Narcotics/Pain medications (ex: Codeine, Morphine, Tramadol)
• Non-Steroid Anti-inflammatory Drugs (ex: Naproxen, Ibuprofen)
• Anti-epileptics (ex: Phenytoin, Gabapentin)

Most of these medications can decrease your alertness, cause fatigue, dizziness, and drop your blood pressure when you stand up (also referred to as postural hypotension).¹

Postural hypotension occurs in about 30% of older adults and may experience one of these symptoms within 1 minute to several minutes of standing up:⁴

• Lightheadedness
• Blurred vision
• Headache
• Fatigue
• Weakness

If you are taking any of these medications, experiencing any of these symptoms or taking more than 6 medications, talk to your doctor about your risk for a fall.⁴ Your doctor may need to reduce or change your medication to help reduce your symptoms and fall risk, never make any changes to your medication without consulting your doctor first.

Balance, medications, and home safety should be addressed in everyone at high risk.⁴ To help maintain the highest level of mobility and reduce your chances of falling or risk of injury, follow up with your doctor. Your doctor can provide tips and recommend exercises designed to prevent falls and help avoid unnecessary trips to the Emergency Department.

References:

1. Berg, R. and Cassells, J. (1992). Falls in Older Persons: Risk Factors and Prevention. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK235613/ [Accessed 18 Jul. 2018].
2. gov. (2018). Important Facts about Falls | Home and Recreational Safety | CDC Injury Center. [online] Available at: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html [Accessed 20 Jul. 2018].
3. de Jong, M., Van der Elst, M. and Hartholt, K. (2013). Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety, 4(4), pp.147-154.
4. Phelan, E., Mahoney, J., Voit, J. and Stevens, J. (2015). Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 99(2), pp.281-293.
5. Sri‐on, J., Tirrell, G., Kamsom, A., Marill, K., Shankar, K. and Liu, S. (2018). A High‐yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients. Academic Emergency Medicine.

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