Polypharmacy, which means taking multiple medications at the same time, raises the death rate from falls primarily because it increases the risk of side effects that affect balance, cognition, and physical stability. When older adults or frail individuals use many drugs simultaneously, the combined effects can cause dizziness, sedation, low blood pressure, confusion, and muscle weakness, all of which make falls more likely and more dangerous.
To understand why polypharmacy is so risky, it helps to look at how medications interact with the body, especially in older adults. As people age, their bodies process drugs differently—metabolism slows down, kidney and liver function decline, and the brain becomes more sensitive to certain chemicals. This means drugs can build up to higher levels in the body or have stronger effects than intended. When multiple drugs are involved, these effects can multiply or clash, leading to unexpected problems.
One major issue is that many medications prescribed to older adults affect the central nervous system. These include sedatives, sleeping pills, antidepressants, and some painkillers. Taken together, they can cause oversedation, making a person drowsy or confused. This sedation dulls reflexes and awareness, increasing the chance of tripping or losing balance. For example, a person might feel dizzy when standing up quickly because some drugs lower blood pressure, causing a sudden drop in blood flow to the brain (orthostatic hypotension). This can lead to fainting or unsteady walking.
Another factor is the “prescribing cascade,” where side effects from one drug are mistaken for new health problems, leading to the prescription of even more medications. This cycle can spiral, increasing the total number of drugs and the risk of harmful interactions. For instance, a drug causing swelling might be treated with a diuretic, which then causes dehydration and electrolyte imbalances, further weakening the patient.
Polypharmacy also complicates medication management. Older adults often have multiple doctors and pharmacies, making it harder to keep track of all medications. Confusing instructions, complex dosing schedules, and similar-looking pills can lead to mistakes like missed doses or accidental overdoses. These errors can worsen side effects or reduce the effectiveness of treatment, indirectly raising fall risk.
Frailty plays a crucial role. Frail individuals have less physical reserve and are more vulnerable to stressors, including medication side effects. They often have multiple chronic conditions requiring several drugs, which increases the chance of inappropriate or excessive prescribing. Frailty also means that even minor side effects, like slight dizziness or muscle weakness, can tip the balance toward a fall.
Falls themselves are a serious health threat for older adults. They often lead to fractures, hospitalizations, and a decline in independence. When polypharmacy contributes to a fall, the consequences can be more severe because the person may be less able to recover due to the combined effects of illness, frailty, and medication side effects. Studies show that older adults on five or more medications have a significantly higher risk of death within a few years, partly because of falls and their complications.
Pharmacist-led interventions have shown promise in reducing fall risk by reviewing medications and deprescribing unnecessary or harmful drugs. Tools exist to identify medications that increase fall risk, such as those causing sedation or blood pressure drops. However, challenges remain, including limited follow-up, low uptake of recommendations, and the complexity of managing multiple conditions safely.
In summary, polypharmacy raises the death rate from falls because the combined effects of multiple medications impair balance, cognition, and physical function, especially in older and frail adults. This leads to more frequent and severe falls, which in turn increase mortality. Managing polypharmacy carefully through medication reviews, clear communication, and attention to frailty can help reduce these risks.