Medication use in seniors after falls is a significant factor that can increase mortality risk, especially when multiple drugs are involved or when certain types of medications are used. Older adults are particularly vulnerable because their bodies process drugs differently due to age-related changes, and many medications can affect balance, cognition, and blood pressure, all of which contribute to fall risk and complications after a fall.
Several classes of medications are known to increase the risk of falls in seniors. These include psychoactive drugs such as benzodiazepines, antidepressants, antipsychotics, and opioids, which can cause sedation, dizziness, confusion, or impaired coordination. Antihypertensives, especially vasodilators and beta-blockers, can lower blood pressure excessively, leading to dizziness or fainting. Anticholinergics can cause confusion and delirium, further increasing fall risk. Other medications like proton pump inhibitors may increase injury risk during falls, and anticoagulants raise the danger of bleeding complications if a fall causes trauma.
The more medications an older adult takes—known as polypharmacy—the higher the risk of falls and subsequent mortality. Studies have shown that seniors taking five or more drugs have a significantly increased risk of death within a few years, partly due to adverse drug effects and interactions that impair physical and cognitive function. This risk is compounded after a fall, as medications can worsen the severity of injuries or complicate recovery.
Falls in older adults are rarely caused by a single factor; they result from a complex interplay of intrinsic factors like age-related decline, chronic illnesses, and medication side effects, combined with extrinsic factors such as environmental hazards. Medications that impair alertness, slow central nervous system processing, or cause orthostatic hypotension (a sudden drop in blood pressure upon standing) directly contribute to falls. After a fall, medications that increase bleeding risk or impair healing can increase mortality risk.
The American Geriatrics Society maintains the Beers Criteria, a list of medications that are potentially inappropriate for older adults due to their risks, including increased fall risk and mortality. This list helps clinicians identify drugs that should be avoided or used with caution in seniors. Commonly flagged medications include sedatives, certain pain medications, some antihistamines, and drugs with strong anticholinergic effects.
In practice, managing medication in seniors who have fallen involves careful review and often deprescribing—reducing or stopping medications that increase fall risk without compromising treatment of underlying conditions. This approach can help reduce the likelihood of subsequent falls and improve survival chances.
In summary, medication use, especially polypharmacy and certain high-risk drug classes, significantly increases mortality risk in seniors after falls by contributing to both the likelihood of falling and the severity of outcomes. Careful medication management is essential to minimize these risks and improve the health and safety of older adults.