How Taking Too Many Medications May Increase Your Fall Risk – and What You Can Do About It
What is Polypharmacy?
Polypharmacy, also known as polytherapy, co-prescribing, and multiple medication use, is widely defined as taking five or more medications. This can be common among older adults as additional health issues creep up with age (Delara et al., 2022; Pazan & Wehling, 2021). As many as 43% of adults 65 years of age and older are prescribed enough medications to meet criteria for polypharmacy (Hung et al., 2024). This is not always a problem, as these medications may all be appropriately prescribed to treat medical issues.
However, polypharmacy is associated with an increased risk of falls, hospitalization, adverse effects, and drug interactions. These negative consequences are particularly significant for older adults, who metabolize medications at slower rates, and may have higher blood levels of medication due to higher relative fat stores (Canio, 2022). An increased blood level of medications can increase their potency and the risk of side effects. Inappropriate polypharmacy can occur when medical providers in different practices or specialties do not have the opportunity to communicate adequately or share complete medical records (Hung et al., 2024). Additionally, polypharmacy can result from a prescribing cascade, which occurs when a side effect of one medication is treated by an additional medication (Canio et al., 2022).
How Can Polypharmacy Lead to Falls?
Taking five or more medications has been found to increase fall risk by 21%, while taking 10 or more medications increases the risk by 50% (Hoel et al., 2021). But how does polypharmacy affect your risk of falling?
One component of the risk is drug-drug interactions, which are 86% more likely when taking six or more medications together (Canio, 2022). These interactions can cause drowsiness and/or dizziness, which both increase the risk of falling. Additionally, advanced age is associated with increased sensitivity to certain medication classes, including benzodiazepines and anticholinergic agents, whose effects may be dangerously amplified (Hoel et al., 2021). Further, medications that act on the central nervous system (the brain and spinal cord) can cause confusion and delayed reaction time (Shao et al., 2023). Taking medications differently than prescribed, such as taking a different dose or taking at a different frequency, can also cause unexpected negative side effects. These medication interactions and side effects can all increase the likelihood of a fall.
How can I Lower my Fall Risk?
The most important step you can take to reduce fall risk is to have a conversation with your doctor about which medications you take and the reasons for which they are prescribed. Your doctor may determine that you no longer need a certain medication and safely discontinue its use. The process of weaning off medication(s) is known as deprescription. Using a multidisciplinary approach and communicating with different members of your care team appears to be the most effective method of deprescription (Hung et al., 2024). Specific strategies for medication management include reviewing your medication list with a pharmacist to determine redundant or inappropriate medications and clarifying your care goals as a patient so that your provider knows what functions to focus on. These conversations and the process of deprescription can happen at your primary care, or at a specialty center such as the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife. Primary care providers have specific deprescription guidelines, which typically involve slowly tapering off one medication at a time (Canio, 2022). It is very important that you take your medications as directed, and do not discontinue any prescription medication without physician supervision.
Research has shown that many conditions can be managed without medications using lifestyle interventions, which (unlike medication) have little to no side effects. It is very important to implement the healthy lifestyle choices that your doctor suggests, which can reduce the number of medications needed to control your health conditions (Hoel et al., 2022). In addition to managing your medications, it is important to consider the safety of your living environment for fall risk (Shao et al., 2023). Balance issues are the most common cause of falls, so preserving balance and mobility is key to avoiding adverse medication effects and drug interactions (Xu et al., 2022).
Through a strategic conversation with your doctor, you may be able to reduce your medications, which lowers your fall risk at the same time by reducing drug interactions and side effects. It’s an easy step for a simpler routine and a safer, healthier you!
References
Canio W. C. (2022). Polypharmacy in Older Adults. Clinics in geriatric medicine, 38(4), 621–625. https://doi.org/10.1016/j.cger.2022.05.004
Delara, M., Murray, L., Jafari, B., Bahji, A., Goodarzi, Z., Kirkham, J., Chowdhury, M., & Seitz, D. P. (2022). Prevalence and factors associated with polypharmacy: a systematic review and Meta-analysis. BMC geriatrics, 22(1), 601. https://doi.org/10.1186/s12877-022-03279-x
Hoel, R. W., Giddings Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients. Mayo Clinic proceedings, 96(1), 242–256. https://doi.org/10.1016/j.mayocp.2020.06.012
Hung, A., Kim, Y. H., & Pavon, J. M. (2024). Deprescribing in older adults with polypharmacy. BMJ (Clinical research ed.), 385, e074892. https://doi.org/10.1136/bmj-2023-074892
Pazan, F., & Wehling, M. (2021). Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. European geriatric medicine, 12(3), 443–452. https://doi.org/10.1007/s41999-021-00479-3
Shao, L., Shi, Y., Xie, X. Y., Wang, Z., Wang, Z. A., & Zhang, J. E. (2023). Incidence and Risk Factors of Falls Among Older People in Nursing Homes: Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 24(11), 1708–1717. https://doi.org/10.1016/j.jamda.2023.06.002
Xu, Q., Ou, X., & Li, J. (2022). The risk of falls among the aging population: A systematic review and meta-analysis. Frontiers in public health, 10, 902599. https://doi.org/10.3389/fpubh.2022.902599