Medication and Falls in the Elderly

The following is a literature review of the article “Medication Use as a Risk Factor for Falls Among Hospitalized Elderly Patients” by Paul C. Walker, Pharm. D., Ahmad Alrawi, Pharm.D., John F. Mitchell, Pharm.D., Randolph E. Regal, Pharm. D., and Ujjaini Khanderia, Pharm. D. The article originally appeared in The American Journal of Health-System Pharmacy, volume 62 issue 23, in December 1, 2005.

A recent study was conducted at the University of Michigan Medical School to determine the impact of certain medications on the frequency of falls in elderly patients in hospitals. Researchers observed prior to the study that falls are a serious problem regarding care of the elderly, with 35-40% of elderly patients experiencing a fall every year. They attributed a majority of these falls to the effects of medications including sedation, hypertension, and cognitive impairment. With this in mind, the researchers conducted their study to better understand how some medications can cause falls in the elderly.

The Study
The study was approved by the institutional review board of the University of Michigan Medical School. This study was retrospective in that information was collected from hospital medical records for elderly patients who had reported falling while in the hospital. Data was collected for the year 2002, and 62 patient records were selected from the 158 reported fall incidents. The information was then sorted based on a number of parameters including age, gender, enzyme levels, and medication use during hospital admission. Statistical analysis was then performed on the data, and results were ascertained.

The Results
The study revealed that age and gender were not factors that increased or affected the frequency of falls in elderly patients. However, patients who experienced falls received more medications prior to the incident than patients who received minimal medication. Patients who received nonsteroidal antiinflammatory drugs (NSAIDs), such as aspirin, fell more often than patients who did not receive NSAIDs. Other drugs that appeared to increase the frequency of falls in the elderly included:

• Anticholinergic agents
• Antidiabetic agents
• Antiepileptic agents
• Antihistamines
• Gastrointestinal agents
• Cardiovascular agents

While there was an apparent influence of these drugs on the occurrence of falls in the elderly, the study lacked a number of controls including health status, completion of medical records, and fall protocols, possibly skewing the study’s results. However, researchers concluded that there was a significant relationship between the occurrence of falls in the elderly and the use of NSAIDs, specifically aspirin.