Experts Link Rise in Senior Fall Deaths to Common Prescription Drugs
Public health researchers point to growing use of fall risk–increasing drugs as a likely contributor to a threefold rise in post-fall mortality among older Americans over three decades
The risk of death after a fall among older adults in the United States has roughly tripled over the past 30 years, and public health experts say increasing use of certain prescription medications may be an important, but underrecognized, driver of the trend.
In a commentary published in JAMA, Thomas A. Farley, a Washington, D.C.–based public health expert, and investigators publishing in BMC Geriatrics argue that lifestyle changes alone cannot account for the rise and that greater use of fall risk–increasing drugs, or FRIDs, parallels the surge in fall-related fatalities.
FRIDs are a broad class of medications that can impair balance, alertness and coordination through effects such as drowsiness, dizziness and slowed reaction times, according to the Centers for Disease Control and Prevention. The category includes drugs commonly prescribed to older adults, among them beta-blockers for heart conditions, anticholinergics for allergies and bladder problems, proton pump inhibitors for acid reflux and central nervous system agents such as opioids, benzodiazepines, gabapentinoids and many antidepressants.
Farley and the BMC Geriatrics authors said the most concerning drugs are those that act on the brain and nervous system because they can both increase the likelihood of a fall and worsen the severity of injuries when falls occur. They wrote that reconsidering the use of unnecessary FRIDs could be a ‘‘simple but powerful’’ approach to reducing fall rates and preserving safety, independence and activity in older adults.
Epidemiologic studies provide supporting, though not definitive, evidence. A Swiss cohort study that followed adults 74 and older for three years found that taking any FRID was associated with a 13 percent higher risk of falling, a 15 percent higher risk of suffering an injurious fall and a 12 percent greater chance of recurrent falls. The risks grew for people taking multiple FRIDs: researchers reported 22 percent more total falls and 33 percent more injurious falls among those on several such medications.
Clinicians cautioned that associations in observational studies do not prove causation and that individual risk assessment remains essential. "The easiest way to think of medications that increase the risk of falls is any medication that changes a person’s ability to clearly perceive and navigate the world," said Dr. Kenneth J. Perry, a physician based in South Carolina. He noted that standing and walking require complex coordination among multiple body systems and that many medications can interfere with that coordination.
Perry and other physicians emphasized that older adults should not abruptly stop medications without consulting their primary care clinician. "There is always a risk associated with taking any medication, but the intent is to make sure that the benefits outweigh the risks," Perry said. He recommended individualized discussions between patients and providers to weigh the therapeutic benefits of a drug against its potential to increase fall risk.
The authors and commentators also noted limitations in the current evidence. Confounding factors such as underlying illness that both prompts medication use and increases fall risk can blur cause-and-effect relationships. Trials that directly test the impact of deprescribing FRIDs on fall-related mortality are limited.
Nonetheless, clinicians and public health experts point to deprescribing initiatives and targeted medication reviews as practical steps. Such reviews typically involve primary care physicians, pharmacists and geriatric specialists working with patients to identify medications that might be reduced, substituted or stopped when risks outweigh benefits.
As the population ages and prescription drug use continues to expand, researchers say more detailed surveillance and intervention trials are needed to clarify how much reducing FRID use could reverse the upward trend in fall-related deaths. In the meantime, experts recommend that clinicians routinely assess fall risk when prescribing medications for older adults and engage patients in conversations about the risks and benefits of their drug regimens.
Public health authorities advise that fall prevention among older adults should include attention to medication management alongside other measures such as home safety assessments, vision correction, exercise to maintain strength and balance, and treatment of conditions that affect gait and equilibrium. Those steps, combined with careful prescribing, may help reduce both the frequency and the consequences of falls in older populations.