The following are some published facts concerning the incidence, cost and common
causes of fatal and non-fatal falls in the elderly.
Falls among adults age 65 and older are very costly.
Each year about $50 billion is spent on non-fatal fall injuries
and $754 million is spent on fatal falls.
For non-fatal falls:
$29 billion is paid by Medicare
$12 billion is paid by Private or Out of Pocket payers
$ 9 billion is paid by Medicaid
As the number of Americans, age 65 and older, grows we can expect the number of
fall injuries and the cost to treat these injuries to soar.
The fatal fall rate for people 65 and older jumped 31 percent from 2007 to
2016, making falls the leading cause of injury-related death among
people in this age group, according to a recent report from the Centers for
Disease Control and Prevention.
Analyzing data compiled from death certificates from all 50 states and the District of
Columbia, researchers found that
29,668 adults suffered fall-related deaths in 2016
a rate of 61.6 per 100,000
a rate of 47 per 100,000 in 2007.
Other findings from 2016:
Elderly women suffered more fall-related deaths than elderly men, but the fatal fall
rate for men (72.3 deaths per 100,000) was higher than for women (54 per
Among age subgroups, seniors 85 and older had a fatal fall rate of 257.9 per
The rate was 61.4 for 75- to 85-year-olds and
15.6 for 65- to 74-year-olds.
Medications are among the most common causes of increased fall risk in
Medications are usually among the easiest risk factors to change, when it comes to
falls in older adults.
Medication-based risks are often missed by busy regular doctors.
Older adults and family caregivers can make a big difference by being proactive in
Once you’ve identified these medications, healthcare providers are supposed
to work with you to try to reduce or eliminate the use of such
This process is called “deprescribing”.
3 categories of medication that should be reviewed to prevent falls
These medications generally fall into one of two three broad categories:
Medications that affect the brain.
Health professionals often refer to these drugs as “psychoactives.”
These are drugs that affect brain function.
Many tend to cause some sedation or drowsiness.
They can also cause or worsen confusion, especially in people with memory
problems or Alzheimer’s disease.
Most of these medications are listed in the 2015 American Geriatrics Society
Updated Beers Criteria: Medications that Older Adults Should Avoid or Use with
Medications that affect blood pressure.
These are drugs that can cause or worsen a sudden fall in blood pressure (BP).
A drop in BP — or chronically low BP — can increase fall risk.
Older adults can easily experience a drop in blood pressure when they stand. This is
called postural (or orthostatic) hypotension.
Most medications for high blood pressure can cause or worsen postural
Medications such as tamsulosin (brand name Flomax) and related medications to
improve urination can also cause postural hypotension.
Medications that lower blood sugar.
This is only a consideration for older adults with diabetes. But as this condition
affects an estimated 25% of people over age 65, these medications are relevant to
People with diabetes have a higher risk of falls compared to others of the same
Hypoglycemia (low blood sugar) due to medications is one of many factors that has
been associated with falls in people with diabetes.
10 Commonly Used Types of Medications
that Increase Fall Risk in Seniors
This list is mainly based on the CDC’s flyer: Medications Linked to Falls and the
American Geriatrics Society’s, Clinical Practice Guidelines on Fall Prevention.
Medications that affect the brain (“psychoactives“)
This class of medication is often prescribed to help people sleep, or to help with
They do work for this purpose, but they are habit-forming and have been
associated with developing dementia.
Commonly prescribed benzodiazepines include lorazepam, diazepam,
temazepam, alprazolam (brand names Ativan, Valium, Restoril, and
Clinical research studies consistently find that benzodiazepines are associated with
increased fall risk.
Note that it can be dangerous to stop benzodiazepines suddenly. These drugs
should always be tapered, under medical supervision.
2. Non-benzodiazepine prescription sedatives.
These drugs are usually prescribed to treat insomnia or sleep difficulties.
This group includes the “z-drugs”: zolpidem, zaleplon, and eszopiclone (brand
names Ambien, Sonata, and Lunesta, respectively).
These have been shown in clinical studies to impair balance — and thinking!
These are medications originally developed to treat schizophrenia and other
illnesses featuring psychosis symptoms.
They are commonly prescribed to control difficult behaviors in Alzheimer’s and other
They are also sometimes prescribed to people with depression.
Commonly prescribed antipsychotics are mainly “second-generation” and include
risperidone, quetiapine, olanzapine, and aripiprazole (Risperdal,
Seroquel, Zyprexa, and Abilify, respectively).
The first-generation antipsychotic haloperidol (Haldol) is still sometimes used.
Clinical research indicates that antipsychotics are associated with increased falls.
Most of these drugs were originally developed to treat seizures.
They are also used to stabilize mood in conditions such as bipolar disorder, and to
treat difficult dementia behaviors.
They can also be used to treat certain types of nerve pain.
Valproic acid (brand name Depakote) is a mood stabilizer that is sometimes
used to manage difficult behaviors in Alzheimer’s or other dementias.
Clinical research suggests that anticonvulsants are associated with increased fall
They also tend to have many other problematic side-effects in older adults.
Gabapentin (Neurontin) is another seizure medication that is often used to treat
nerve pain. Some research suggests it may not affect balance as much as some
These are medications prescribed to treat depression.
Some of them are also used to treat anxiety.
Selective serotonin-reuptake inhibitors (SSRIs) include sertraline, citalopram,
escitalopram, paroxetine, and fluoxetine (brand names Zoloft, Celexa,
Lexapro, Paxil, and Prozac, respectively).
Other antidepressants commonly used include mirtazapine, bupropion, and
venlafaxine (brand names Remeron, Wellbutrin, and Effexor,
Tricyclic antidepressants include amitryptiline and nortriptyline (brand names
Elavil and Pamelor, respectively).
These antidepressants are quite anticholinergic and are no longer often used to
They are still used to manage nerve pain.
Trazodone is an older antidepressant that is now used almost exclusively as a mild
Virtually all antidepressants have been associated with an increase in fall risk.
6. Opioid (narcotic) analgesics.
Opioids are mainly used for the treatment of pain.
Commonly used opioids include codeine, hydrocodone, oxycodone, morphine,
fentanyl, and methadone.
Opioids often cause drowsiness, as well as other side-effects.
Clinical research on the association between opioids and increased fall risk in older
adults has shown mixed results. A 2009 meta-analysis of medications and fall risk
did not find that opioids were associated with falls.
However some experts — including the CDC — still recommend that narcotic use be
evaluated as part of fall risk management.
This group covers most over-the-counter sleeping aids, as well as a variety of other
These are medications that have the chemical property of blocking the
A large number of drugs of different classes have strong anticholinergic activity.
Sedating antihistamines, such as diphenhydramine (brand name Benadryl).
The “PM” versions of over-the-counter analgesics (e.g. Nyquil, Tylenol PM); the
“PM” ingredient is usually a sedating antihistamine.
Medications for overactive bladder, such as the bladder relaxants oxybutynin and
tolterodine (brand names Ditropan and Detrol, respectively).
Medications for vertigo, motion sickness, or nausea, such as meclizine,
scopolamine, or promethazine (brand names Antivert, Scopace, and
Oral medications for itching, such as hydroxyzine and diphenhydramine
(brand names Vistaril and Benadryl).
Muscle relaxants, such as cyclobenzaprine (brand name Flexaril).
“Tricyclic” antidepressants and also the SSRI paroxetine (brand name Paxil)
Anticholinergics commonly cause sedation. They can also cloud thinking and have
been associated with developing dementia.
Clinical research on anticholinergics and fall risk has shown mixed results. A recent
clinical study found that the association was not statistically significant.
Still, given that anticholinergics can cause drowsiness and are risky for seniors for
other reasons, many experts believe it’s reasonable to include them when reviewing
medications for fall prevention.
Medications that affect blood pressure
A large number of different medications are commonly used to treat high blood
Clinical research on blood pressure (BP) medications and fall risk has shown mixed
Although one study found that BP medications were associated with injurious falls,
another recent study found no association between BP medications and falls.
Some research suggests that diuretics may be associated with higher fall risk than
other classes of BP medication. Meta-analyses have generally been unable to
confirm that antihypertensives increase fall risk.
Despite the mixed clinical evidence, many geriatricians and other experts do
recommend re-evaluating BP medications in older adults at high risk for falls.
9. Other medications that affect blood pressure.
There are some commonly used medications that are not usually prescribed for
hypertension, but still lower BP or increase postural BP changes in many older
Alpha-blockers are a class of medication now mainly used to help men with benign
prostatic hypertrophy urinate.
They include tamsulosin, terazosin, doxazosin, and prazosin (brand names
Flomax, Hytrin, Cardura, and Minipress, respectively).
A 2015 study found that the use of prostate-specific alpha blockers was associated
with a higher risk of fall and fracture in older men.
Medications that lower blood sugar (for people diagnosed with diabetes)
10. Medications that lower blood sugar.
Many older adults with diabetes take medications to keep their blood sugar from
getting too high.
Most diabetes medications can cause or worsen hypoglycemia (too low blood
Metformin (brand name Glucophage) is notable in that it causes minimal
risk of hypoglycemia, unless it’s being taken in combination with insulin
or other diabetes drugs.
Research studies have found that hypoglycemia is associated with falls in older
Here’s what the CDC is telling healthcare providers to do about
medications linked to falls:
STOP medications when possible.
SWITCH to safer alternatives.
REDUCE medications to the lowest effective dose.
As a patient or concerned family member, it’s vital that you actively participate in
this process with your healthcare providers.
Reducing and stopping medication use is our mission at Veritas Health Analytics.
Our approach is to work to get the body healthy enough so that the person is no
longer dependent upon medications. If you or anyone that you know is interested
In reducing medication use, give us a call to find out more about our program and
how it can help you.
Yours for Better Health,
Dr. Henry Bulitta