Medication reduction, particularly through careful review and deprescribing of certain drugs, can potentially lower mortality related to falls, but the relationship is complex and not guaranteed by medication reduction alone. Falls in older adults are a major cause of injury and death, and many medications increase the risk of falling by causing dizziness, sedation, or impairing balance. Therefore, reducing or adjusting these medications can reduce fall risk and possibly the severity of injuries sustained, which in turn may lower mortality.
Many older adults take multiple medications, a situation known as polypharmacy, which increases the likelihood of adverse drug reactions and falls. Certain classes of drugs, such as opioids, benzodiazepines, antidepressants, and gabapentinoids, are known as fall risk-increasing drugs (FRIDs). These medications can cause sedation, impaired cognition, or muscle weakness, all of which contribute to falls. Studies have found that a large proportion of older adults who suffer fall-related injuries are on at least one FRID, and often multiple such drugs. Reducing or deprescribing these medications when possible is a key strategy to lower fall risk.
However, medication reduction as a single intervention has shown mixed results in preventing falls or reducing mortality. Some research indicates that medication review and deprescribing alone may not be cost-effective or sufficient to reduce falls significantly. This is partly because falls are multifactorial; they result from a combination of factors including muscle weakness, balance problems, vision impairment, environmental hazards, and underlying diseases such as Parkinson’s or arthritis. Thus, medication adjustment needs to be part of a broader, multifaceted approach including physical therapy, vision correction, and management of chronic conditions.
Importantly, some medications, like anticoagulants, increase the severity of injuries from falls by raising bleeding risk. In such cases, careful risk-benefit analysis is essential. For example, stopping anticoagulants may reduce bleeding complications but increase the risk of stroke or thrombosis. Clinicians must weigh these risks carefully and educate patients on fall prevention and immediate post-fall care.
Pharmacist-led interventions that focus on medication review and deprescribing have demonstrated improvements in medication appropriateness and reductions in potentially inappropriate prescribing and adverse drug reactions. These interventions can reduce the medication burden and improve overall medication safety. However, evidence that these interventions directly reduce hospitalizations, falls, or mortality is limited, possibly due to short follow-up periods, small study sizes, or incomplete implementation of recommendations.
In addition to medication management, treatments that improve bone density, such as calcium, vitamin D, and bisphosphonates, can reduce fracture risk if a fall occurs, thereby potentially lowering mortality from fall-related injuries. Addressing other risk factors like vision impairment, urinary urgency, and mobility limitations is also critical.
In summary, while reducing or optimizing medications that increase fall risk is an important component of fall prevention and may contribute to lowering mortality from falls, it is not a standalone solution. Effective fall prevention and mortality reduction require a comprehensive approach that includes medication review, physical therapy, environmental modifications, management of chronic diseases, and bone health optimization.
