Adults over 60 who are taking mood-altering medications and sedatives have an increased risk of falling, which can lead to serious injuries and even death, according to a new report authored by scientists at the University of British Columbia.
The review article, published Monday in Archives of Internal Medicine, suggests some medications can boost seniors' chances of falling by nearly 1.7 times.
The authors analyzed 22 studies published between 1996 and 2007 and found that among various medications commonly prescribed to seniors, antipsychotics, antidepressants and sedatives were the ones that increased the risk of a fall most dramatically.
Many of these drugs can leave patients feeling sleepy, dizzy and light-headed, which makes them more susceptible to falls. As well, because they have more difficulty than younger people in metabolizing medications, the drugs can hit their bodies harder.
"In this population, it's taking them a long time to recover from [falls]" said John Woolcott, a graduate student of pharmaceutical sciences at UBC and lead author of the study. "A hip fracture is a devastating event."
Carlo Marra, another of the study's authors, says the biggest issue is that people over 60 are already at an increased risk of falling than the general population, and are often prescribed mood-altering medications or sedatives when there are far less dangerous forms of treatment available, such as psychotherapy.
"There's been a bit of pressure for folks to have the five-minute primary-care consultation," said Dr. Marra, an associate professor of pharmaceutical sciences at UBC. "Maybe it's an easier approach for a busy practitioner rather than going with some other, less risky treatment."
Just a few years ago, mental health professionals were decrying a lack of recognition of depression as a serious mental illness, but now the opposite may be happening and doctors may be over-medicating their patients, said David Conn, the chief of psychiatry at Baycrest, a Toronto health sciences centre focused on geriatric care.
He prescribes antidepressants to his patients who suffer from major depression, but opts for psychotherapy or other treatments for milder cases and says this can be just as effective. Sometimes that isn't an option, though.
"I don't think we have enough psychotherapists available to treat everyone who could benefit from it," Dr. Conn said.
While most younger people who suffer from falls recover quickly, individuals over 60 aren't as lucky - they have nine times more fall injuries than younger populations, according to a 2005 report from the Public Health Agency of Canada. Falls cause 90 per cent of hip fractures among seniors, and in 15 to 20 per cent of those cases, the patients will die from complications.
"When you look at somebody who's 80 years old, if they're osteoporotic, are on multiple medications for health issues, they're more likely to wind up in the hospital [after a fall]with major injuries such as a fractured hip," says Rhonda Lovell, a public health nurse in Kingston, Ont., and chair of the Kingston, Frontenac and Lennox & Addington Falls Prevention Coalition.
Hospitalization can start a chain reaction, she says. Treatment for the hip fracture usually means more medications, which can cause adverse reactions. Underlying health issues might also be exacerbated by injuries from a fall. And if a senior must undergo surgery to treat a fall-related injury, they're at risk for infections and clotting.
"Consider that our population is aging. If multifaceted [fall-]revention programs aren't put in place, those numbers are going to increase at, unfortunately, a very high, fast rate," Ms. Lovell said.