The percentage of US adults 65 and older who received a prescription for a drug that increased their risk of falling rose to 94% in 2017—a significant leap from 57% in 1999, researchers report.
The research also shows that the rate of fall-caused deaths in older adults more than doubled during the same time period.
Even minor falls may be dangerous for older adults. Falls that are not fatal can still result in injuries—such as hip fractures and head traumas—that may drastically lower remaining quality of life. Each year, nearly $50 billion is spent on medical costs related to fall injuries among older adults, according to the Centers for Disease Control and Prevention.
The alarming results solidify the importance of interventions to de-prescribe potentially inappropriate drugs among older, frailer patients, says Amy Shaver, lead investigator and postdoctoral associate in the School of Public Health and Health Professions at the University at Buffalo.
“Our study indicates two trends increasing concurrently at a population level that should be examined at the individual level. Our hope is it will start more conversations on health care teams about the pros and cons of medications prescribed for vulnerable populations,” says Shaver.
The study in Pharmacoepidemiology and Drug Safety examines data on deaths due to falls and prescription fills among people 65 and older from the National Vital Statistics System and the Medical Expenditure Panel Survey.
Fall-risk-increasing drugs include antidepressants, anticonvulsants, antipsychotics, antihypertensives (for high blood pressure), opioids, sedative hypnotics, and benzodiazepines (tranquilizers such as Valium and Xanax), as well as other nonprescription medications.
From 1999-2017, older adults filled more than 7.8 billion fall-risk-increasing drug orders in the United States. The majority of the prescriptions were for antihypertensives. However, there was also a sharp rise in the use of antidepressants, from 12 million prescriptions in 1999 to more than 52 million in 2017.
“The rise in the use of antidepressant medications seen in this study is likely related to the use of these agents as safer alternatives to older medications for conditions such as depression and anxiety,” says Shaver. “However, it is important to note that these medications are still associated with increased risks of falls and fractures among older adults.”
The study shows women are more likely than men to receive a prescription for fall-risk-increasing drugs, particularly Black women, who received the medications at the highest rate compared to women of other races. White women 85 and older experienced the largest increase in deaths from falls, rising 160% between 1999 and 2017.
The investigators are involved in multidisciplinary de-prescribing initiatives conducted through Team Alice and the University at Buffalo Center for Successful Aging. The efforts encourage and evaluate patient/caregiver-initiated de-prescribing conversations with health care providers, promote interprofessional education on de-prescribing, and advocate for policy and system changes.
The National Cancer Institute funded the research, in part.
Source: University at Buffalo