Medication and Falls
Original Editors - Scott Buxton
Top Contributors -Scott Buxton, Lucinda hampton, Sai Kripa, Kim Jackson, WikiSysop, Evan Thomas and Chelsea Mclene
What is Polypharmacy?[edit | edit source]
Polypharmacy is typically defined as the use of more than 3 or 4 medications[1][2], take a moment and think of the number of patients you have that are taking more than 3 medications. Thought also needs to be spent on which types of medications the patient is taking as different classes of drug influence the risk of falls differently. The video below gives a good brief summary of polypharmacy in the elderly.
A 2017 study reported that almost one-third of the total population using five or more drugs had a significantly increased rate of falls (21%) over a 2-year period. It concluded that exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required.[4]
Medications Associated with Increased Risk of Falls[edit | edit source]
As physiotherapists it is important to be aware of which medications can impact on our patients safety, medication is obviously not within a physiotherapist job role specifically however knowing what the potential impact of some medications can be very valuable. Additionally it is important to know about the medications if you work in a triage role. If you are concerned about the type or number of medications a patient is taking then spend time referring to you medical colleagues in the clinic, writing to their GP or discussing at and MDT meeting.
Psychotropic Drugs[edit | edit source]
Medication Group | Overall Risk Category | Commonly Used Medications | Effects on Risk |
Sedatives |
HIGH RISK Can cause falls alone |
Lorazepam, Temazepam, Nitrazepam similar -epamsuffix |
Drowsiness, slows reactions, impaired balance. |
Sedating Antidepressants |
HIGH RISK Can cause falls alone |
Amitriptyline, Nortriptyline | Orthostatic hypotension, drowsiness, slow reactions. DOUBLE THE RATE OF FALLS |
Monoamine Oxidase Inhibitors |
HIGH RISK Can cause falls alone |
Phenelzine, Moclobemide | Severe orthostatic hypotension |
For Psychosis Agitation |
HIGH RISK Can cause falls alone |
Haloperidol, Chlorpromazine, Olanzapine | Orthostatic hypotension, slow reflexes, loss of balance |
Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitor )SNRI) |
MODERATE RISK Can cause falls in combination |
Fluoxetine, Sertaline, Paroxetine, Venlafaxine, Duloetine | Increased risk of falls with fractures, orthostatic hypotension, bradycardia, impaired sleep quality |
Opiate Analegsics |
HIGH RISK Can cause falls alone |
Codeine, Morphine, Tramadol | Sedates, slows reactions, impairs balance, delirium |
Anti Epileptics | HIGH RISK | Phenytoin, Carbamazepine, Phenobarbitone | Cerebellar damage, ataxia, slowed reactions |
MODERATE RISK | Sodium Valporate, Gabapentin | Some association with falls risk | |
Parkinson's Disease - Dopamine Agonists | HIGH RISK | Roprinerole, Pramipexole | Delirium, orthostatic hypotension |
Parkinson's Disease - MAOI-B Inhibitors | HIGH RISK | Selegiline | Orthostatic hypotension (Difficult to assess due to high falls risk in PD as the disease process) |
Muscle Relaxant | MODERATE RISK | Baclofen | Reduced muscle tone, sedative |
Vestibular Sedative | POSSIBLE CAUSES | Prochlorperazine, Cinnarazine, Betahistine | Prochlor... - Dopamine agonist which may cause movement disorder in long term, sedating |
Anticholinergics acting on Bladder | POSSIBLE CAUSES | Oxybutinin, Solifenacin, Tolterodine, Solifenacin | Known CNS effects. |
Drugs Actings on the Heart and Circulation[edit | edit source]
Medication Group | Overall Risk Category | Commonly Used Medications | Effect of Risk |
Alpha Receptor blockers | HIGH RISK | Doxasozin, Tamsulosin, Indoramin | Severe orthostatic hypotension, urinary retention |
Centreally Acting Alpha-2-Receptor Agonsits | HIGH RISK | Clonidine, Moxonidine | Severe orthostatic hypotension, sedating |
Thiazide Diuretics | HIGH RISK | Bendroflumethiazide, Metolazone | Weakness due to low potassium, hyponatraemia, orthostatic hypotension |
Loop Diuretic | MODERATE RISK | Furosemide, Bumetanide | Dehydration, hypotension, low potassium and sodium |
Angiotensin Converting Enzyme Inhibitors (ACEIs) | HIGH RISK | Lisinopril, Ramipril -opril | Rely upon kidney elimination and accumulate can cause failure, dehydration. |
Angiotensin Receptor Blockers (ARBs) | MODERATE RISK | Losartan or similar -tan | Hypotension |
Beta Blockers | HIGH RISK | Atenolol, Propranolol, Sotalol | Bradycardia, hypotension, carotid sinus hypersensitivity, vasovagal syndrome |
Antianginals | HIGH RISK | Glyceryl Trinitrate (GTN), Isosorbide Mononitrate, Nico | Sudden hypotension |
Calcium Channel Blockers | MODERATE RISK | Amlodipine, Felodipine, Diltiazem, Verapamil | Hypotension, bradycardia |
Other Antidysrhythmics | MODERATE RISK | Digoxin, Flecainide, Amiodarone | Bradycardia, arrythmias |
Acetylcholinersterase Inhibitors (For Dementia) | POSSIBLE CAUSES | Rivastigmine, Donepezil, galantamine | Bradycardia and syncope |
References[edit | edit source]
- ↑ Ziere G. Dieleman J. Hofman A. Pol A. van der Cammen T. Stricker B. Polypharmacy and Falls in the Middle Age and Elderly Population. British journal of clinical Pharmacology. 2005:61;218-223
- ↑ Evans J. Drugs and Falls in Later Life. Lancet. 2003; 361:448
- ↑ Medski.com. Geriatrics – Polypharmacy in the Elderly: By Balakrishnan Nair M.D. Available from: https://www.youtube.com/watch?v=vGcAr9tK_30 (last accessed 20.5.2019)
- ↑ Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ open. 2017 Oct 1;7(10):e016358. Available from: https://bmjopen.bmj.com/content/7/10/e016358 (last accessed 20.5.2019)
- ↑ 5.0 5.1 Darowski A. Dwight J. Reynolds J. Medicines and Falls in Hospital: Guidance Sheet [ONLINE] available from https://www.rcplondon.ac.uk/sites/default/files/documents/medicines-and-falls2.pdf date accessed 14/01/2015