http://www.healthsentinel.com/org_news.php?event=org_news_print_list_item&id=068

Roman Bystrianyk, "Medication use a major risk factor in falls in the
elderly", Health Sentinel, December 12, 2005,

Falls and related injuries are a serious problem in the elderly.
According to the CDC (Centers for Disease Control) more than one third
of adults over 65 years of age fall each year. Among older adults falls
are the leading cause of injury related deaths and the most common
cause of nonfatal injuries and hospital admissions for trauma. In 2003,
more than 1.8 million seniors over 65 were treated in emergency
departments for fall-related injuries and more that 421,000 were
hospitalized.

In 2002, nearly 13,000 people over the age of 65 died from fall-related
injuries. More than 60% of people who die from falls are over the age
of 75. Of those who fall, 20% to 30% suffer moderate to severe injuries
such as hip fractures or head traumas that reduce mobility and
independence, and increase the risk of premature death. Among people
ages 75 years and older, those who fall are four to five times more
likely to be admitted to a long-term care facility for a year or
longer. In addition, falls are a leading cause of traumatic brain
injury.

A number of risk factors for falls have been previously identified
including medications that cause sedation, low blood pressure, or
cognitive impairment. A number of medications have been implicated as
risk factors for falls including antidepressants, antipsychotics,
antihypertensives, diuretics, and nonsteroidal anti-inflammatories
(NSAIDs). Anticoagulants (blood thinners) have also been implicated in
fall-related injuries by increasing the risk of bleeding.

A study in the December 2005 issue of American Journal of Health-System
Pharmacy examines the relationship between medication use and falls
among the elderly. This was a retrospective, case-controlled study in a
550-bed teaching hospital. A random sampling of 62 patients was taken
from 258 recorded falls during 2002. For each fall a control patient
was matched that did not fall during hospitalization.

In the study, most patients who fell (74%) experienced no significant
injuries. However, of the 62 patients 1 suffered a significant injury
and one patient died as a result of the fall.

After analysis the authors found that "only NSAIDs and other
medications to be significant predictors of falls, with NSAIDs
increasing the risk 10-fold." Although other medications increased
the likelihood of a fall 13.85 times because of the limited size of the
study no single medication could be identified accurately.

Previous studies have already identified the NSAIDs as being a major
health problem. For example, according to a July 1998 Journal of
Medicine study, "Conservative calculations estimate that
approximately 107,000 patients are hospitalized annually for
nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal
(GI) complications and at least 16,500 NSAID-related deaths occur each
year among arthritis patients alone. The figures of all NSAID users
would be overwhelming, yet the scope of this problem is generally
under-appreciated."

The authors conclude that, "we observed a significant positive
association between NSAID use, particularly the use of aspirin, and
patient falls. NSAIDs may potentially increase the risk of falls
because of the adverse CNS [Central Nervous System] effects, which
include confusion, dizziness or light-headedness, drowsiness, and
vision impairment in the elderly, and previous studies have found an
increased risk of falls among users of NSAIDs. In hospitalized elderly
patients, there was a significant association between NSAID use and
falls, an effect largely accounted for by low-dose aspirin."

SOURCE: American Journal of Health-System Pharmacy, December 2005