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Falling is among older Americans’ most pernicious killers. The fall-related death rate for Americans over 65 has more than tripled over the past three decades, according to epidemiologist Thomas Farley. In a recent opinion piece published in The Journal of the American Medical Association (JAMA), he wrote that prescription drugs, including antihistamines and antidepressants, are a culprit, as they can cause dizziness and drowsiness. These substances are also known as “fall-risk-increasing drugs” (FRIDs).
Michael Steinman, a geriatrician and professor of medicine at UCSF, says it’s tough to know whether the rate of deaths related to falls has increased threefold within the last decade. “But in a way, it doesn't really matter because what we do know is that the rate is too high, serious, and that there's something we can do about it.”
He notes that while falls can lead to deaths, sometimes that pathway is indirect. For example, someone falls, breaks their hip, is admitted to the hospital, catches pneumonia, and all those events together eventually lead to death. He says whether the death certificate identifies the fall as the precipitating event could be subjective, and that type of record-keeping might’ve changed over the years.
Plus, over the past decade, people have increasingly used medications that affect the brain and induce drowsiness, which are problematic in increasing the risk of falls, Steinman says.
“A lot of the drugs in these categories, they're things which might slow down our reaction times, make us a little more sleepy, maybe make us feel a little light-headed or a little drowsy or just a tiny bit out of it, even if it's so minor that we wouldn't really notice it in day-to-day life. The cumulative effect … can make the difference between stumbling and catching yourself, and stumbling and hitting the ground.”
Steinman advises that when discussing medications with your doctor, it’s important to ask whether that drug — potential side effects included — is truly the right choice for you, and whether a safer alternative exists.
“The doctor might say, ‘You're right. This drug has some risks, but in your case, the benefits really outweigh those risks.’ But in some cases it might be, ‘Well, that drug … started five years ago. Maybe it's really not needed anymore. Maybe the thing we had started it for [has] already passed … so maybe we could take that drug off, or lower the dose, or find an alternative.’ … Raising that issue with your doctor or other members of health care team is so important, because if you don't raise it proactively, a lot of times, it will never get brought up.”
Other ways to reduce fall risks: Do exercises that strengthen your balance and train your muscles to catch yourself if you start stumbling; remove trip hazards in the home, such as extension cords and slip rugs; wear sensible shoes; ensure good lighting in your environment. |
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