Nearly every older adult was prescribed a prescription drug that increased their risk of falling in 2017, according to new University at Buffalo research. The study found that the percentage of adults 65 and older who were prescribed a fall- risk-increasing drug climbed to 94% in 2017, a significant leap from 57% in 1999. The research also revealed that the rate of death caused by falls 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 $50bn is spent on medical costs related to fall injuries among older adults, according to the US Centres for Disease Control and Prevention.
The alarming results solidify the importance of interventions to de-prescribe potentially inappropriate drugs among older, frailer patients, says Dr Amy Shaver, lead investigator and postdoctoral associate in the UB School of Public Health and Health Professions.
"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.
Additional investigators in the UB School of Pharmacy and Pharmaceutical Sciences include Dr Collin Clark, clinical assistant professor; Dr David Jacobs, assistant professor; Dr Robert Wahler Jr, clinical associate professor; and Dr Mary Hejna, pharmacy resident at Kaleida Health.
The study examined 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, anti-hypertensives (for high blood pressure), opioids, sedative hypnotics, and benzodiazepines (tranquilizers such as Valium and Xanax), as well as other non-prescription medications.
From 1999-2017, more than 7.8bn fall-risk-increasing drug orders were filled by older adults in the US. The majority of the prescriptions were for anti-hypertensives. However, there was also a sharp rise in the use of antidepressants, from 12m prescriptions in 1999 to more than 52m 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."
Women were also found more likely than men to be prescribed fall-risk-increasing drugs, particularly Black women, who received the medications at the highest rate compared to women of other races. White women who were 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 UB Centre for Successful Ageing. The efforts encourage and evaluate patient/caregiver-initiated de-prescribing conversations with health care providers, promote interprofessional education on de-prescribing, and advocate for
The research was funded in part by the National Cancer Institute.
Trends in fall‐related mortality and fall risk increasing drugs among older individuals in the United States,1999–2017
Amy L Shaver, Collin M Clark, Mary Hejna, Steven Feuerstein, Robert G Wahler, David M Jacobs
Published in Pharmacoepidemiology and Drug Safety on 3 February 2021
Previous studies have demonstrated increasing mortality due to falls among older adults. The objective of this study was to determine whether there was an increase in fall risk increasing drug prescribing and if this is concurrent with an increase in fall‐related mortality in persons 65 years and older in the United States.
The study is a serial cross‐sectional analysis utilizing data from both the National Vital Statistics System (NVSS) and the medical expenditure panel survey (MEPS) for years 1999–2017. Adults aged 65 years and older were evaluated for death due to falls from the NVSS and for prescription fills of fall risk increasing drugs per the Stopping Elderly Accidents, Deaths, and Injuries‐Rx (STEADI‐Rx) fall checklist from the MEPS.
The analysis included 374 972 fall‐related mortalities and 7 858 177 122 fills of fall risk increasing drugs. 563 037 964 persons age 65 and older received at least one fall risk increasing drug. Age‐adjusted mortality due to falls increased from 29.40 per 100 000 in 1999 to 63.27 per 100 000 in 2017. The percent of persons who received at least one prescription for a fall risk increasing drug increased from 57% in 1999 to 94% in 2017 (p for trend <.0001).
Conclusions and relevance
Both use of fall risk increasing drugs and mortality due to falls are on the rise. Fall risk increasing drugs may partially explain the increase in mortality due to falls; this cannot be firmly concluded from the current study. Future research examining the potential relationship between fall risk increasing drugs and fall‐related mortality utilizing nationally representative person‐level data are needed.
University at Buffalo material
Pharmacoepidemiology and Drug Safety study (Restricted access)
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