Virginia Geriatrics: Falls in Older Patients

Knowledge	Action
Several drugs have been associated with falls^1,² Psychotropic drugs neuroleptics antidepressants especially tricyclic antidepressants amitriptyline but, also SSRIs benzodiazepines especially long acting flurazepam clonazepam diazepam but, also short acting lorazepam oxazepam temazepam alprazolam triazolam Cardiac drugs diuretics especially in high doses, by causing volume depletion or electrolyte imbalance Type I anti-arrhythmics Digoxin because of decreased renal clearance, dosage > 0.125 mg should be used only if needed to control heart rate in atrial arrhythmias	Minimize use of psychotropic drugs Minimize use of : diuretics type I anti-arrhythmics digoxin
Except when they cause orthostasis or heart block, drugs that are not usually associated with falls include: beta blockers, ACE inhibitors, calcium channel blockers, nitrates. Most narcotics, non-narcotic analgesics and aspirin are usually not associated with falls. Remember not to use Demerol because it is cleared by the kidneys and accumulates in older patients.	Review blood pressure effects of cardiovascular medications and do an EKG to rule out conduction abnormalities. Treat pain appropriately, but avoid Demerol meperidine
Patients taking 4 or more medications are at increased risk of recurrent falls	Avoid polypharmacy

References:

Leipzig RM, Cumming RG, Tinetti ME: Drugs and Falls in Older People: A Systematic Review and Meta-analysis: I. Psychotropic Drugs. J Am Geriatr Soc 47:30-39, 1999
Leipzig RM, Cumming RG, Tinetti ME: Drugs and Falls in Older People: A Systematic Review and Meta-analysis: II: Cardiac and Analgesic Drugs J aM Geriatr Soc 47:40-50, 1999