Public health experts have warned of the perils of falls for older people for decades. In 2023, the most recent year of data from the Centers for Disease Control and Prevention, more than\u00a041,000 Americans over 65\u00a0died from falls,\u00a0an opinion article<\/a>\u00a0in JAMA Health Forum\u00a0pointed out last month.<\/p>\n More startling than that figure, though, was another statistic: Fall-related mortality among older adults has been climbing sharply.<\/p>\n The author, Thomas Farley, an epidemiologist, reported that death rates from fall injuries among Americans over 65 had more than tripled over the past 30 years. Among those over 85, the cohort at highest risk, death rates from falls jumped to\u00a0339 per 100,000 in 2023, from 92 per 100,000 in 1990. The culprit, in his view, is Americans’ reliance on prescription drugs.<\/p>\n “Older adults are heavily medicated, increasingly so, and with drugs that are inappropriate for older people,” Farley said in an interview. “This didn’t occur\u00a0in Japan<\/a>\u00a0or in Europe.”<\/p>\n Yet that same 30-year period saw a flurry of research and activity to try to reduce geriatric falls and their potentially devastating consequences, from hip fractures and brain bleeds to restricted mobility, persistent pain, and institutionalization.<\/p>\n The American Geriatrics Society adopted updated\u00a0fall prevention guidelines<\/a>\u00a0in 2011. The CDC unveiled a program called\u00a0STEADI<\/a>\u00a0in 2012. The United States Preventive Services Task Force recommended exercise or physical therapy for older adults at risk of falling in 2012, 2018, and again\u00a0last year<\/a>.<\/p>\n “There’ve been studies and interventions and investments, and they haven’t been particularly successful,” said Donovan Maust, a geriatric psychiatrist and researcher at the University of Michigan. “It’s a bad problem that seems to be getting worse.”<\/p>\n But are prescription drugs driving that increase? Geriatricians and others who research falls and prescribing practices question that conclusion.<\/p>\n Farley, a former New York City health commissioner who teaches at Tulane University, acknowledged that many factors contribute to falls, including the physical impairments and deteriorating eyesight associated with advancing age; alcohol abuse; and tripping hazards in people’s homes.<\/p>\n But “there’s no reason to think any of them have gotten three times worse in the past 30 years,” he said, pointing to studies showing\u00a0declines in other high-income countries<\/a>.<\/p>\n The difference, he believes, is Americans’ increasing use of medications \u2014 like benzodiazepines, opioids, antidepressants, and gabapentin \u2014 that act on the central nervous system.<\/p>\n “The drugs that increase\u00a0falls’ mortality\u00a0are those that make you drowsy or dizzy,” he said.<\/p>\n Problematic drugs are numerous enough to have acquired an acronym: FRIDs, or “fall-risk-increasing drugs,” a category that also includes various cardiac medications and\u00a0early\u00a0antihistamines like Benadryl.<\/p>\n Such medications play a major role, agreed Thomas Gill, a geriatrician and epidemiologist at Yale University and a longtime falls researcher. But, he said, “there are alternative explanations” for the increase in death rates.<\/p>\n He cited changes in reporting the causes of death, for instance. “Years ago, falls were considered a natural consequence of aging and no big deal,” he said.<\/p>\n Death certificates often attributed fatalities among older people to ailments like heart failure instead of falls, making fall mortality appear lower in the 1980s and 1990s.<\/p>\n Today’s over-85 cohort may also be frailer and sicker than the oldest-old were 30 years ago, Gill added, because contemporary medicine can keep people alive longer.<\/p>\n Their accumulating impairments, more than the drugs they take, could make them more likely to die after a fall.<\/p>\n Another\u00a0skeptic, Neil Alexander, a geriatrician and falls expert at the University of Michigan and VA Ann Arbor Healthcare System, argued that most doctors have come to understand the dangers of FRIDs and prescribe them less often.<\/p>\n “Message delivered,” he said. Given the alarms sounded\u00a0about opioids, about benzodiazepines and\u00a0related drugs,\u00a0and especially about opioids and benzos together, “a lot of primary care doctors have heard the gospel,” he said. “They know not to give older people Valium.”<\/p>\n Moreover, prescriptions for some fall-related drugs have already declined or hit plateaus, even as\u00a0death rates\u00a0because of falls have risen. Medicare data shows\u00a0lower prescription opioid use<\/a>\u00a0beginning a decade ago, for example. Benzodiazepine prescriptions for older patients have slowed, Maust said.<\/p>\n On the other hand, the\u00a0use of antidepressants<\/a>\u00a0and of\u00a0gabapentin<\/a>\u00a0has increased.<\/p>\n Whether or not\u00a0medication use outweighs all other factors, “nobody disputes that these agents are overused and inappropriately used” and contribute to the troubling increase in fall death rates among seniors, Gill said.<\/p>\n Thus, the ongoing campaign for “deprescribing” \u2014 stopping the medications whose potential harms outweigh their benefits, or reducing their dosage.<\/p>\n “We know a lot of these drugs can increase falls by 50 to 75%”\u00a0in older patients, said Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of the\u00a0US Deprescribing Research Network<\/a>, established in 2019.<\/p>\n “It’s easy to start meds, but it often takes a lot of time and effort to have patients stop taking them,” he said. Harried doctors may pay less attention to drug regimens than to health issues that seem more pressing, and patients can be reluctant to give up pills that seem to help with pain, insomnia, reflux, and other common age-related complaints.<\/p>\n The Beers Criteria, a directory of drugs often deemed inadvisable for older adults, recently published\u00a0recommendations<\/a> for alternative medications and nonpharmacological treatments\u00a0for frequent problems. Cognitive behavioral therapy for sleeplessness. Exercise, physical therapy, and psychological interventions for pain.<\/p>\n “It’s a real tragedy when people have this life-altering event,” Steinman, co-chair of the Beers panel on alternatives, said of falls. He urged older patients to raise the issue of FRIDs themselves, if their doctors haven’t.<\/p>\n “Ask, \u2018Do any of my medications increase the risk of falls? Is there an alternative treatment?’” he suggested. “Being an informed patient or caregiver can put this on the agenda. Otherwise, it might not come up.”<\/p>\n The New Old Age is produced through a partnership with\u00a0The New York Times<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n<\/p>\n
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