Although not a DSM diagnosis, fear of falling is recognized as a common source of functional impairment and distress. The author presents 7 commonly prescribed medication categories that may increase fall risk in older adults.
In the elderly, falls are a common and important problem. After a fall-related injury, many older adults can have a fear of falling, a common geriatric condition marked by anxiety and low self-confidence about walking safely. The author presents 7 commonly prescribed medication categories that may increase fall risk in older adults.
Note: most of these medications also cause cognitive impairment and increase risk of delirium in older adults (eg, centrally acting anticholinergics, antihistaminergics, and sedatives).
Fear of falling is recognized as a common source of functional impairment and distress (and increased risk of falls) in older adults.
A case of an elderly woman.
Category 1: Benzodiazepines Examples: clonazepam, alprazolam, diazepam, lorazepam Action: Avoid; stop when feasible; taper to lower doses
Category 2: Other sedatives Examples: “Z-drugs”: zalephon, zolpidem, eszopiclone Action: Choose safer insomnia treatments, such as behavioral therapy, trazodone, or melatonin
Category 3: Strong, centrally acting anticholinergics and antihistamines used for non-CNS indications Examples: Diphenhydramine; loratadine; overactive bladder medications (oxybutynin, tolterodine, fesoterodine); bowel medications (eg, hyoscyamine, dicyclomine) Action: Stop: if treatment is needed, switch to a non-CNS penetrant antihistamine (cetirizine) or anticholinergic (trospium, loperamide)
Category 4: Tricyclic antidepressants Examples: Particularly tertiary amine (amitriptyline, imipramine, doxepin) Action: If a tricyclic is needed, use a secondary amine (nortriptyline, desipramine)
Category 5: Some antipsychotics Examples: First-generation antipsychotics (high potency via inducing parkinsonism; low potency via parkinsonism and anticholinergic effects); olanzapine Action: Use a second-generation antipsychotic with low or no anticholinergic effects (risperidone, aripiprazole, quetiapine)
Category 6: Some mood stabilizers and anti-epileptics Examples: Lithium, valproate, carbamazepine, oxcarbazepine, topiramate (if at high doses/levels); barbiturates (such as phenobarbital and primidone); gabapentin or pregabalin (if at high doses) Action: Use minimal effective dose; stop or avoid sedatives that can magnify fall risk
Category 7: Some psychotropic combinations Examples: Paroxetine + bupropion; high-dose fluoxetine or duloxetine + bupropion; multiple sedatives Action: Avoid or use reduced doses
