How to incorporate falls assessment

Medications and the Risk of Falling
Which drugs can increase the risk of falls?
In theory ANY drug that causes one of the following effects can increase the risk of falling: As well, theoretically ANY drug that causes the following effects can increase the risk of a serious outcome if an individual falls: • Osteoporosis or reduced bone mineral density: Increased risk of fracture if a fall • Bleeding risk: Increased risk of a cerebral hemorrhage if a fall occurs What can be done if you are taking a drug that can increase the falls risk?
Individualize treatment. Drugs are just one of many factors that can increase the risk of falling. Assessment: Are you at high risk?
… Have you had a slip, trip, near fall or fall in the last 6 months?
taking a drug that can cause the effects listed above
… Are you taking a high dose of the drug?
displaying any of the adverse effects listed above, such as
… Are you over the age of 65? Elderly patients may be more sensitive to adverse drug effects because of alterations in the way that the body absorbs, distributes or eliminates the drug. taking more than one drug that increases the falls risk?
… Are you at high risk of falling for other, non-drug reasons?
difficult for you or your doctor to monitor for an adverse drug effect?
Consider intervention, especially if you have assessed the patient as high risk: • Consider risk/benefit ratio: Does the benefit of the drug outweigh a possible risk • Is there a safer drug or non-drug alternative? • Is it possible to minimize the dose without losing the benefit of the drug? Medications and the Risk of Falling
Examples of drugs that can increase the risk of falling, or of a serious
outcome if a fall occurs (and possible mechanisms)

ACE Inhibitors (3)
Eye drops (6)
Herbal and
Natural health
Natural sleep aids
Natural products
Alcohol (1,5)
for sexual
Proton Pump
Inhibitors (9)
Alpha Receptor
Muscle Relaxants
Anticoagulants (8)
Nitrates (2,3)
sedating (1)
Possible mechanisms (often unclear): (1) Drowsiness; (2) Dizziness; (3) Hypotension; (4)
Parkinsonian effects; (5) Ataxia/gait disturbance; (6) Vision disturbance; (7) Osteoporosis or reduced bone mineral density increases the fracture risk if a fall occurs; (8) Risk of serious bleeding if a fall occurs. Drugs are listed by generic (chemical) name under each drug group. For Brand (manufacturer’s) names, check in the CPS to find the generic name. This list includes only those drugs for which there is evidence of increased risk of falls or their consequences. There may be other drugs that increase this risk in certain patients. Barbara Cadario and BC Falls and Injury Prevention Coalition. Drugs and the Risk of Falling: Guidance Document. Revised August 2011.


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