Medicines and falls risk in care homes
For prescribers and all staff responsible for administering medications in care homes.
Download a full version of this information by following the link to the pdf on the right.
How falls happen
Falls don’t just happen. There’s often, more than one underlying cause or risk factor.
As the number of risk factors increases, so does the risk of falling. Many falls are linked to a person’s physical condition and/or a medical problem. Other risk factors could be hazards in the person’s home or community environment.
Some medications can increase a person’s risk of falling because of its action or associated side effects. These include:
- dizziness
- sedation
- confusion
- low blood pressure
- postural hypotension.
Older people are more vulnerable to the side effects of medications because of age related changes to the liver, kidney, central nervous system and heart.
Aim
This information is a reference guide to raise awareness of medicines that can cause or contribute to falls in older people.
Key messages
Falls may happen due to recent medication changes but usually caused by medicines that have been given for a long time without appropriate review.
The more medications a person takes the greater the falls risk. The significance of side effects is likely to increase if people are taking medications with similar side effects.
The possibility of syncope or near syncope should be considered in unexplained falls. Some medications commonly used in the elderly can cause syncope, for example, acetylcholinesterase inhibitors (for dementia) and some antianginals, which would need a review.
Falls are multifactorial.
The risk of having a fall increase with the number of risk factors below. Those with 4 or more risk factors have the greatest risk of having a fall.
Risk factors include:
- previous falls
- poor mobility
- muscle weakness
- postural hypotension
- low blood pressure
- sedating medications
- balance disorder
- dementia or cognitive impairment
- visual and hearing problems
- having more than 1 unit per day of alcohol.
The most common reasons for medications to cause falls are:
- sedation leading to impaired balance and slowed responses
- postural hypotension, which is an abnormal drop in blood pressure on standing up.
Recommendations
Healthcare professionals should review if a resident has had any falls previously and the frequency within the past year. You should consider the characteristics and the environment of the fall/s.
The use of certain medications is a major and modifiable risk factor for falls.
Many falls can be prevented and fall, and injury prevention needs multidisciplinary management.
There’s evidence that these medicines increase falls risk in older adults, referred to as falls-risk-increasing-drugs (FRIDs). A structured approach involving a medication review and deprescribing of FRIDs can significantly reduce falls risk.
Any resident that has had an acute fall should have a medication review by the appropriate clinician to reduce, stop or change any medications that may
cause sedation or have an effect on blood pressure. Frail older people should have personalised targets for their blood pressure control, taking into account their preferences alongside co-morbidities and possible side effects of medications.
Alert the appropriate clinician to any changes in a resident’s mobility, balance, coordination or alertness especially following any medication changes.
A multifactoral risk assessment should happen for older people who:
- need medical attention due to a fall
- report recurrent falls in the past year
- establish abnormalities of gait and/or balance
A healthcare professional with appropriate skills and experience should do this, usually in the setting of a specialist falls service.
Multifactorial falls risk assessment
A resident at risk of falls may be offered an assessment. This aims to identify a person’s risk factor of falling. It should be an individualised approach dependent upon the resident and may include an identification and review of falls history, as well as:
- an assessment of strength, gait, balance and mobility
- assessment of osteoporosis risk
- fracture risk review
- review of visual impairment
- cognitive impairment review
- neurological examination
- review of urinary incontinence
- review of medication.
Commonly prescribed drugs that can contribute to falls
For a full list of the most commonly prescribed drugs that can contribute to falls risk, and ther grading, download a pdf copy of this information by following the link at the top right of this page.