Study suggests antidepressants, antipsychotics, other sedating drugs increase risk of falls

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By Sheryl Ubelacker
THE CANADIAN PRESS

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TORONTO - Seniors who take certain medications like antidepressants and sleeping pills that have a sedating effect are at greater risk of falling, say researchers, suggesting that doctors need to take more care in prescribing such drugs.

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A recent study has found that certain medications can increase the risk of falls among seniors.

In an analysis of 22 international studies, researchers at the University of British Columbia found that seniors on antidepressants, antipsychotics and sedative-hypnotics were 1 1/2 times more likely to take a spill compared to those not taking the drugs.

Principal author Dr. Carlo Marra, a UBC pharmacist and epidemiologist, said one in three Canadians over 65 living in the community experiences a fall each year. For those over age 80, that figure rises to 40 per cent.

"These findings reinforce the need for judicious use of medications in elderly people at risk of falling," Marra said.

"Safer alternatives, such as counselling, shorter-term or less-sedating therapies, may be more appropriate for certain conditions."

Co-author John Woolcott said alternatives may include implementing an exercise program to improve strength, balance and flexibility and fall-proofing the person's home.

Installing handrails, using proper lighting and removing small mats and rugs are among the suggested ways to help make homes fall-proof.

"We know that seniors are falling, and we know that the population of seniors is growing, so falls as a problem is getting larger and larger," Woolcott said from Vancouver.

"And the costs associated with falling are quite significant and the outcome of a fall can be quite devastating to a senior."

Taking a spill is no minor occurrence: statistics show that 90 per cent of all hip fractures are caused by falls.

And among seniors living in the community who fracture a hip, one in five will die and 15 per cent will have to move into a long-term care facility.

The analysis, which looked at data from more than 79,000 participants overall, showed antidepressants had the strongest association with tumbles, possibly because older drugs in this class have significant sedative properties.

Anti-psychotics -- often used to treat schizophrenia and other psychoses -- and benzodiazepines such as Valium also has a strong link to falls, the researchers report in this week's issue of the journal Archives of Internal Medicine.

Marra said the researchers were surprised to find that some drugs that reduce blood pressure can also lead to spills, particularly if blood pressure drops suddenly when a person stands up, for instance.

Another surprising link was seen between use of non-steroidal anti-inflammatories (NSAIDS) and a higher propensity for falls.

"We're not sure why we found that, but maybe that's a marker for things like osteoarthritis, where maybe somebody has knee pain or knee instability and perhaps that's leading to the fall rather than the drug," Marra said.

"I think it's kind of important to interpret the results in those contexts and to get the message out there that there's medications ... that predispose the elderly to falling."

Dr. Barbara Liu, a geriatrician at Sunnybrook Health Sciences Centre in Toronto, said it's been known for some time that certain drugs are connected with a higher risk of falls.

"I think it is worth repeating because falls are an important issue in older people and medications are a variable that can be modified or adjusted to reduce the risk," she said, agreeing that exercising and fall-proofing the living environment are good places to start.

But that doesn't mean that people should come off those medications, said Liu, who was not involved in the study.

"We have a significant problem with undertreatment of treatable conditions amongst older people," she said.

"For example, depression is a treatable illness, and I wouldn't want people to take themselves off antidepressants when it's warranted ... but at the same time we shouldn't be using these medications without appropriate cautionary measures."