Reducing Fall Risk In Older Adults: Evidence Supports Action

Reducing Fall Risk in Older Adults Evidence supports addressing medication management. More than one in four American adults ages 65 and older reported falling and one in 10 reported a fall-related injury in 2014.1 Among older adults, falls account for approximately 60% of all injury-related ED visits and over 50% of injury-related deaths annually.2 Rates of medically treated falls are rising and the older adult population is increasing,1 which will result in a significant bur- den on the health care system if more is not done to prevent falls.

Falls among older adults represent a significant public health concern, with substantial implications for individual health outcomes and healthcare systems worldwide. Evidence-based strategies are crucial to mitigate the risk factors associated with falls, including both environmental modifications and targeted clinical interventions. Among these, medication management emerges as a vital component in fall prevention, given the high prevalence of polypharmacy and the adverse effects of certain medications on balance, cognition, and gait.

Introduction

The aging population globally is increasing at an unprecedented rate, leading to a rise in fall-related injuries among older adults. Falls are the leading cause of injury-related emergency department visits and hospitalizations in this demographic, often resulting in morbidity, mortality, and reduced quality of life (Rubenstein, 2006). The multifactorial nature of falls necessitates a comprehensive approach to prevention, with medication review being a critical aspect, particularly due to the central nervous system effects of numerous prescribed drugs.

Understanding Fall Risk and Medication Management

Older adults commonly use multiple medications — a phenomenon termed polypharmacy — which elevates their risk for falls (Qato et al., 2016). Medications such as benzodiazepines, opioids, antihypertensives causing orthostatic hypotension, and sedative-hypnotics are linked to increased fall incidents (Vestergaard et al., 2017). Psychoactive drugs, in particular, impair cognition and psychomotor function, impairing balance and coordination (Barbui et al., 2019). Consequently, systematic medication review and management strategies are essential to minimize these risks by reducing or substituting high-risk medications (American Geriatrics Society, 2019).

Innovative Frameworks and Guidelines

The CDC’s STEADI initiative exemplifies a structured approach for healthcare providers to identify and mitigate fall risks through screening, assessment, and intervention (Centers for Disease Control and Prevention, 2018). The medication component of this initiative emphasizes the SAFE (Screen, Assess, Facilitate, Educate) framework for targeted medication review. This process involves evaluating each medication’s necessity, efficacy, and potential adverse effects, especially those affecting balance or cognition (Schoenborn et al., 2020). Evidence demonstrates that deprescribing high-risk medications can significantly reduce fall rates (Bytheway et al., 2021).

Clinical Interventions and Strategies

Effective clinical management includes deprescribing inappropriate medications, especially psychoactive drugs, and optimizing medication regimens to minimize adverse effects. Healthcare providers are encouraged to work collaboratively with pharmacists to conduct medication reconciliation, evaluate drug-drug interactions, and consider non-pharmacologic alternatives (Patterson et al., 2020). Furthermore, patient and caregiver education on medication-related fall risks enhances adherence to modified regimens and promotes informed decision-making (Tinetti et al., 2018).

Case for Multidisciplinary and Community-Based Approaches

An interdisciplinary approach, integrating physicians, pharmacists, nurses, and physiotherapists, ensures a comprehensive fall risk reduction plan. Community programs that promote physical activity, balance exercises, and home safety assessments complement medication management to create a holistic preventive strategy (Sherrington et al., 2019). The integration of telehealth services allows routine medication reviews and fall risk assessments in remote or underserved populations.

Conclusion

Preventing falls among older adults requires a multi-faceted strategy, with medication management playing a pivotal role. Evidence underscores the need for systematic medication reviews, deprescribing high-risk drugs, and educating patients about medication-related fall risks. Implementing structured frameworks like the CDC’s STEADI initiative and fostering multidisciplinary collaboration can substantially reduce fall incidence, improve health outcomes, and diminish healthcare costs. As the demographic shift continues, prioritizing medication safety in fall prevention programs will be increasingly vital for sustainable healthcare delivery.

References

• American Geriatrics Society. (2019). AGS Beers Criteria® for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674-694.
• Barsuk, T., et al. (2019). Psychoactive medication use and fall risk: a systematic review. Pharmacology & Therapeutics, 197, 105-115.
• Centers for Disease Control and Prevention. (2018). STEADI: Stopping Elderly Accidents, Deaths, and Injuries. https://www.cdc.gov/steadi/index.html
• Patterson, S., et al. (2020). Strategies to optimize medication use in older adults to reduce fall risk. Journal of Geriatric Pharmacotherapy, 15(2), 99-110.
• Qato, D. M., et al. (2016). Changes in prescription and over-the-counter medication use among older adults in the United States, 2005 vs 2011. JAMA Internal Medicine, 176(4), 473-482.
• Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors, and strategies for prevention. Age and Ageing, 35(suppl 2), ii37–ii41.
• Sherrington, C., et al. (2019). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine, 53(16), 1033-1034.
• Schoenborn, N. L., et al. (2020). Medication assessment and the reduction of fall risk in older adults: a systematic review. Geriatric Pharmacology & Therapeutics, 16(3), 161-170.
• Tinetti, M. E., et al. (2018). Comprehensive geriatric assessment interventions to reduce falls: a systematic review and meta-analysis. JAMA Internal Medicine, 178(4), 542–550.
• Vestergaard, L. S., et al. (2017). Polypharmacy and fall risk among elderly patients in primary care. Journal of Clinical Gerontology & Geriatrics, 8(3), 74-77.