The November issue of the Archives of Internal Medicine brings more attention to an increase of falls in patients who are on sedatives, sleeping pills, anti-depressants or benzodiazepines. We discussed the recent article, and how drugs such as Ambien, Valium and other drugs in this category are related to increased falls on Channel 7.
First, let’sw review the article that was published last week.
In the Archives article, the authors looked at the data from 22 previous studies and combined the results using a technique called meta-analysis. By doing this, and looking at nine categories of drugs such as high blood pressure medications, anti-inflammatory agents, as well as the sedatives, hypnotics and antidepressants and hypnotics, they wanted to see if there was a relation between any of the drugs and an increased risk of falling in those over 65. The results showed that even after correcting for other risks for falling, the sedatives, hypnotics, antidepressants and benzodiazepines showed a significant association with falling in this age group.
This mirrors information that is used to gauge risks for falling in hospitalized patients. Falls are a significant cause of injuries and additional cost, not to mention prolonged recovery for people and worldwide the cost of these falls is estimated to be in the billions of dollars.
The study addressed these concerns related to falls –including the fact that falls are the fifth leading cause of death in the developed world. Just how big is this problem? Actually, the statistics they quote are startling. 30 percent of all people 65 and over will fall each year. Not only that, but 85% of all injury related hospital admissions are related to falls, and 40% of all nursing home admissions are related to falls. As we grow older, our sense of balance tends to decrease, and medical conditions can create additional risks for falling such as poor muscle strength, dizziness and side effects from medications.
This study clearly shows that there are certain drugs that should be used only when absolutely necessary in older adults.
All of these drugs are all relatively common prescription drugs. Does this article mean that they are not safe?
The drugs are safe when used as prescribed, and when a person’s reaction to them is well known. However, all drugs and over the counter medications have side effects – or undesireable results of taking the drug.
The drugs listed in the study as related to falls all have side effects that include sleepiness, slower reaction times. In addition, we know from the medical literature that some people get unusual side effects from sleeping pill including not remembering what they have done, sleep walking, from these medications. ,
Often, older individuals need reduced doses of medications, and, since they are more likely to be on more than one medication, they need to be sure and let their physician and pharmacist know all the drugs they take, even if only once in a while.
So what are the take-aways from this study?
1) REVIEW YOUR MEDICATIONS WITH YOUR DOCTOR OR PHARMACIST – Everyone, and especially those over the age of 65, should review their medication lists with their doctors or pharmacists for the medications found to increase falls – sleeping pills, benzodiazepines, antidepressants and hypnotics – and review the continued need for the medication.
2) THOSE OVER 65 MAY NEED SMALLER DOSES THAN YOUNGER ADULTS
3) FALL-PROOF YOUR HOME – remove area rugs, make certain that the lighting is good (particularly near the stairways) and install grab rails in the bath.
4) READ SIDE EFFECTS AND WARNINGS CAREFULLY
5) DO EXERCISES TO IMPROVE YOUR CORE MUSCLE STRENGTH THAT WILL HELP YOU MAINTAIN YOUR BALANCE
6) HAVE YOUR VISION CHECKED
Good Health! Dr. Dianne
If you want more information, here are some helpful sites:
Tue, Dec 1, 2009
Patient Safety