As a Doctor of Physical Therapy, I get asked this question a lot. Just insert any pronoun that you prefer, i.e. my Dad, my Mom, my Aunt, my Grandpa, and so on. After all, falls, repeated falls, are a reality for literally one quarter of the population in the USA who are older than 65 years! The answer to this question is not a one sentence answer. It is not a one paragraph answer. And at the risk of sounding cliche I would say, “it depends.” The root cause of why falls are happening is a crucial piece of information to prescribing a remedy for prevention. The key thing to remember is that falls may be caused by multiple things and finding one specific cause may not be as simple as it sounds. This is why experts such as Physical Therapists and Occupational Therapists are such excellent resources when it comes to fall prevention; the detective work is what some of us love to delve into when it comes to aging adults. Not to mention, we therapists are all trained to assess such issues when it comes to home safety, etc. The best way to stop Grandma from falling is to look at all of the areas that may contribute to falls and how they can be adjusted. As you will see, the primary care physician or specialist(s) who are caring for Nana are also an important part of preventing falls. Let’s dive into these areas next. There are only a handful, but these are the ones I consider to be among the most important.
The medications that your loved one is taking make a huge difference in their risk of falling. Granny only needs to be on 4 prescription medications or more to be considered at risk for falling. This is called “poly-pharmacy.” Regardless of medication type or mechanism, poly-pharmacy is an automatic fall risk. This is in part due to the fact that medications may interact with each other to create other symptoms. The other issue on top of poly-pharmacy is duplication, where the primary care physician or other physicians may prescribe multiple medications that do the same thing, e.g. blood pressure pills. Although intentions are good, duplication may result in too much of a good thing. In our example, too many blood pressure pills may result in the BP becoming too low and resulting in passing out and fatigue. Many medications also have side effects that can result in automatic fall risk even when prescribed by themselves. These include barbiturates, opioids, benzodiazepines, antipsychotics, antidepressants, and more. In addition, many medications have side effects such as dizziness or light-headedness. A complete list of medications that may be a “no-no” for aging adults are found in the Beers Criteria published by the American Geriatrics Society.
You may consider sharing this with your Grandma’s physician. A summary can be found using this link: https://www.guidelinecentral.com/summaries/american-geriatrics-society-2015-updated-beers-criteria-for-potentially-inappropriate-medication-use-in-older-adults/#section-society
So the key point here is that physicians need to be a part of your fall prevention team in that they need to be reviewing the entire medication list annually, if not semi-annually, to ensure that there is no duplication and/or to find alternative medications to help with treated conditions. Reduction in medications, when possible, is not a bad thing. This may be a root cause of that fall she had when getting up to use the bathroom at 3 AM…
Dr. Michael Hyland, DPT, CEEAA has been a physical therapist since 2012. He is a Certified Exercise Expert for the Aging Adult and an expert in Parkinson's Disease. He owns Hyland Physical Therapy and Wellness in Broken Arrow, OK