Falls (health and wellbeing needs in South Tyneside)
Medication and Falls
Inappropriate polypharmacy is when medications are prescribed which are no longer needed. This can be because they are no longer clinically indicated, their benefit does not outweigh the risks, the combination of medication has potential to or is actually causing harm and / or the patient is unwilling to take the medication as prescribed.
The NHS Scotland Polypharmacy guidance outlines that in patients over the age of 65 years of age, and on five or more medications, 50% of hospital admissions due to adverse drug events are preventable. By addressing inappropriate polypharmacy and involving the patient in decisions about their medication we can improve health outcomes, reduce the risk of hospital admissions, and reduce the risk of errors or adverse drug reactions.
Many medications can contribute to falls or increase the severity of a fall if they cause bleeding or increased fracture risk. The list below details some of the effects medication can cause which could increase a patients' falls risk:
- Sedation, drowsiness or dizziness
- Impaired postural stability or muscle weakness
- Orthostatic hypotension
- Hypoglycaemia
- Dehydration
- Confusion
- Vestibular damage
- Drug induced parkinsonism
- Visual impairment
- Anticholinergic side effects (more than one of these medications given together can increase the risk of side effects)
As patients age, often they will develop multiple co-morbidities, this in turn prompts prescribing of medication to treat or prevent progression of a disease. Using multiple medications together provides a higher risk of side effects which are then often treated with more medication leading to inappropriate polypharmacy. Many patients therefore are prescribed medication that was initiated many years ago for an indication that is no longer relevant and could be receiving minimal benefit but still experiencing side effects [25] [26] [27].