During the pandemic, when access to medical care and orthopedic surgery were compromised, many people found themselves being prescribed and taking more painkillers and anti-inflammatories to manage their chronic pain. As elective surgeries were push back and delayed, more pills were given.

Painkillers and anti-inflammatories medications come with many well known and well documented side effects. Among these side effects is the increased risk that the person will take a fall significant enough to fracture a hip.

Let’s note that pain doctors have suggested that pain was a substantial risk factors for falls. A 2014 study wrote: “Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.”

Falls amongst older people are common; however, around 40% of falls could be preventable

In November 2020, (1)  researchers in the United Kingdom noted that while “Falls amongst older people are common; however, around 40% of falls could be preventable.” How are they preventable? To this research team the answer was to reduce a patient’s medication usage. The research team continued: ” Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy (medication usage) and fall-related hospital admissions.”

The findings here suggest that the more medications one takes, the greater the risk of fall. In this study of over 6,000 patients, 15% of those taking excessive (some say unnecessary medications) wound up in the hospital from a fall. The conclusion the researchers reached was: “The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.”

Fall risk increasing drugs (FRID) – an understudied topic

A December 2021 paper (2) also warned of a seemingly unnoticed problem of fall risks and over prescribing of medication. Here is what these researchers wrote: “The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient (at home) injuries. . . Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk . Persistent polypharmacy with Fall risk increasing drugs (FRID) use was associated with a 48% increase in fall injury risk  vs. those who had non-persistent polypharmacy without FRID use . . . Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk.”

Poorer balance, physical function and strength and reported increased concern about falls

A March 2020 study (3) looked at 70 year old and older patients who suffered with knee pain. Compared to a similar group with no knee pain, these patients took more medications and had more medical conditions. In addition, the people with knee pain had poorer balance, physical function and strength and reported increased concern about falls. Sixty one participants (20%) reported more than two falls, with the people in the knee pain group twice as likely to experience multiple falls over the 12 month follow up. The researchers concluded their paper by suggesting: “This study has identified several medical, medication, psychological, sensorimotor, balance and mobility factors to be associated with knee pain, and found the presence of knee pain doubles the risk of multiple falls in older community living people. Alleviating knee pain, as well as addressing associated risk factors may assist in preventing falls in older people with knee pain.”

1 Zaninotto P, Huang YT, Di Gessa G, Abell J, Lassale C, Steptoe A. Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing. BMC public health. 2020 Dec;20(1):1-7.
2 Xue L, Boudreau RM, Donohue JM, Zgibor JC, Marcum ZA, Costacou T, Newman AB, Waters TM, Strotmeyer ES. Persistent polypharmacy and fall injury risk: the Health, Aging and Body Composition Study. BMC geriatrics. 2021 Dec;21(1):1-0.
3 Hicks C, Levinger P, Menant JC, Lord SR, Sachdev PS, Brodaty H, Sturnieks DL. Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people. BMC Geriatr. 2020 Mar 6;20(1):94. doi: 10.1186/s12877-020-1487-2. PMID: 32138672; PMCID: PMC7059317.

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