The Common Meds That Make You More Likely To Die From A fall

A recent (published last month, at time of writing) US-specific paper on this topic begins with the words:

❝In 2023, more than 41 000 individuals older than 65 years died from falls. Among older adults, the number of deaths from falls is more than from breast or prostate cancer and is more than from car crashes, drug overdoses, and all other unintentional injuries combined. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. In contrast, death rates due to falls decreased during the past 30 years in other high-income countries.❞

Let’s take a moment to look at that piece by piece:

“In 2023, more than 41 000 individuals older than 65 years died from falls”

To contextualize this, that’s a lot. That is significantly more people than were killed in the World Trade Center attack in 2001, for example.

“Among older adults, the number of deaths from falls is more than from breast or prostate cancer and is more than from car crashes, drug overdoses, and all other unintentional injuries combined”

This is interesting, because those are all things that a lot of people put a lot of effort into avoiding. We read carefully about what things might affect cancer risk, we do appropriate screenings, we have big national campaigns raising awareness about them, and the same for drink-driving, and let us not even get started on the War on Drugs™.

But how often do we see such attention being paid to reducing the number of deaths from falling?

“More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. In contrast, death rates due to falls decreased during the past 30 years in other high-income countries”

Thus, this is a US-specific problem. So, what gives?

Land of the FRIDs

The main reason, the paper argues, is fall-risk-increasing drugs (FRIDs).

This is a broad category, but the drugs found most culpable are those that affect the brain or balance, such as benzodiazepines, opioids, some antidepressants, gabapentin, certain heart drugs, some antihistamines, β-blockers, and anticholinergics, amongst many others.

There are also drugs that don’t increase fall risk per se, but do increase fall mortality, such as proton pump inhibitors, since they increase the risk of an injury during a fall.

You may be wondering: how do we know this is what’s to blame, and not other factors?

And the answer is: we can’t know for sure, but statistical analysis strongly points the finger on this one. And yes, sometimes such analyses can miss something really important; see for example:

Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health – by Dr. Marty Makary

But as this paper notes:

❝The surge in deaths from falls in the US reflects a new phenomenon. There is no reason to think that older adults today are much more likely to be physically frail, have dementia, have cluttered homes, or drink alcohol and use drugs than age-matched adults 30 years ago, and the percentage living alone has not changed much since 2000.

On the other hand, there is plenty of reason to believe that the surge in fall deaths may be tied to the soaring use of certain prescription drugs, which is a risk factor that, unlike most other factors, clinicians can readily modify.

Older adults in the US are heavily medicated. From 2017 to 2020, 90% of adults older than 65 years were taking prescription drugs, 43% were taking multiple prescription drugs, and 45% were taking prescription drugs that were potentially inappropriate.❞

You can read the paper in full, here: Risky Prescribing and the Epidemic of Deaths From Falls

And as for those potentially inappriopriate medications, check out our previous main feature on such:

Are You Taking PIMs? Getting Off The Overmedication Train

What more can we do?

You may be thinking “but all my medications are definitely necessary”, and you might well be right. So, what then?

For the answer, check out our Fall Special ← this is about how to not fall, and how to make it less likely you’ll be injured by a fall if you do

Take care!