Falls are a significant health concern among older adults. The Australian Falls Guidelines highlight medicines as a major, modifiable risk factor for falls in older adults living in the community. It’s essential for people working with older adults to understand the impact of medications on falls risk, and the strategies available to reduce these risks.
How do medications contribute to falls in older adults?
Approximately 30% of those aged 65 and over experience at least one fall each year. Research indicates that medications contribute to 10-25% of these falls through various mechanisms, including the use of multiple medications, also known as polypharmacy. Each additional medication increases the risk of falling by about 14%, particularly if it causes side effects such as drowsiness, confusion, or blurred vision. Older adults are more susceptible to side effects because their bodies process medicines differently. Medicines such as psychotropics, antihypertensives, opioids, and anticholinergic medicines increase the risk of falls.
Medicine reviews are an important part of fall presentation and risk assessment
Regular medication reviews can reduce the risk of falls by up to 20%. Health professionals should proactively talk with older adults about practical ways to stay safe, especially when taking medicines that increase the risk of falls. These conversations are especially important if someone has had a recent fall, when starting a new medication, or increasing a dose, as fall risk may increase during these periods. Encourage individuals to promptly report symptoms such as dizziness, light‑headedness or unsteadiness. Simple strategies like standing up slowly from a chair or bed and taking time to regain balance can significantly reduce the risk of falls.
Health professionals should proactively talk with older adults about practical ways to stay safe, especially when taking medicines that increase the risk of falls. These conversations are especially important if someone has had a recent fall, when starting a new medication, or increasing a dose, as fall risk may rise during these periods. Encourage individuals to promptly report symptoms such as dizziness, light‑headedness or unsteadiness. Simple strategies like standing up slowly from a chair or bed and taking time to regain balance can significantly reduce the risk of falls.
In Western Australia, several tools and services support medication review:
The Australian Falls Guidelines encourage a multifactorial approach to medication management. Health and community workers should refer older adults to to a medical practitioner, nurse practitioner and a pharmacist to take the best possible medication history and review of all the older person’s medicines. Services to help include:
- Home Medicines Review (HMR): Conducted by an accredited pharmacist with the patient’s GP, this review thoroughly examines all medications to spot and resolve any problems contributing to falls risk.
- Residential Medication Management Review (RMMR): Similar to HMR, this review is for aged care residents, aiming to optimize medication use and minimize risks.
- MedsCheck and Diabetes MedsCheck: Available through community pharmacies, these services offer opportunities for patients to have their medications reviewed by a pharmacist, ensuring understanding and identifying potential issues.
Falls risk assessment tools, such as the Falls Risk for Older People in the Community (FROP-Com) and the Falls Risk Assessment Tool (FRAT), are available to assess various risk factors, including medications. Primary Health workers play a crucial role, with regular consultations and reviews essential for adjusting medications and reducing polypharmacy.
The Preventing Falls and Harm from Falls in Older People: Best Practice Guidelines for Community Care in Australia (Falls Guidelines for Community Care) aims to improve the safety and quality of care for older people and offers a nationally consistent approach to preventing falls and harm from falls in community care settings.