Falls and medicines: the connection families should know about
Certain medicines — sedatives, some blood pressure medicines, strong pain medicines and others — are a recognised, checkable contributing factor to falls in older people. A medication review can’t promise to stop a fall, but it can identify which of your family member’s medicines may be adding to that risk, and put it in writing for their GP to act on.
Nobody wants to hear that a tablet their parent has taken for years might be part of why they’re less steady on their feet. It’s an easy thought to push aside. But in clinical guidance written for GPs caring for older patients, medicines are named as one of the more common, and more checkable, pieces of the falls picture1 — which is exactly why it’s worth naming plainly rather than skirting around.
What kinds of medicines are linked to falls?
Several groups of medicines turn up again and again in Australian clinical guidance on falls in older people. The RACGP’s own aged care clinical guide lists taking more than three medications at once as a risk factor, particularly sedatives such as benzodiazepines, some antidepressants, medicines with anticholinergic effects, and blood pressure medicines (antihypertensives).1 Medicines used to lower blood sugar in diabetes are on the same list, because a low blood sugar episode can itself bring on dizziness or a fall.1
Separately, healthdirect, Australia’s government-run health information service, names sleeping tablets and strong pain medicines containing opioids specifically, alongside some antidepressants, as medicines that can increase the risk of a fall by causing drowsiness, confusion, unsteadiness or dizziness.2 None of this means any one of these medicines is wrong for your family member. It means they’re worth a second look, particularly when several are taken together.
Why would a tablet make someone more likely to fall?
The mechanisms are fairly ordinary once they’re named. Some medicines cause drowsiness or slower reaction times as a side effect.2 Others, including some blood pressure medicines, can drop blood pressure suddenly when a person stands up, a reaction called postural hypotension, which can bring on light-headedness or fainting.1 Medicines with anticholinergic effects, a group that includes some medicines for bladder problems, allergies and sleep, can affect balance and clear thinking in older people specifically, sometimes even at a dose that caused no trouble a few years earlier.2 The more of these a person takes together, the more these effects can stack up rather than simply add up one by one.
Does this mean these medicines are wrong for my parent?
Not necessarily, and it’s worth saying that clearly. Many of these medicines are treating something real, and are the right choice for your family member. A blood pressure medicine that’s doing its job, or a sleeping tablet started after months of genuine insomnia, isn’t automatically a mistake. The point of a review isn’t to second-guess every prescription on sight. It’s to check, systematically, whether the combination your family member is actually taking still makes sense together, and whether anything on the list falls into a recognised falls-risk category worth their GP’s attention.
What does a medication review actually do about this?
During a Home Medicines Review, I go through every medicine your family member takes, prescription and over-the-counter, and note anything that falls into a recognised falls-risk category, along with doses, combinations, and anything that’s changed recently.4 That goes into a written report back to their GP, alongside anything you or your family member have mentioned noticing, such as unsteadiness, a near-miss, or dizziness on standing.
What I don’t do is decide to stop or change a medicine myself. That decision belongs to your family member’s GP, who knows their full history and can weigh the benefit of a medicine against the risk it may be contributing.3,4 A review’s job is to make sure that decision is an informed one, not to make it on the GP’s behalf.
A medication review doesn’t prevent falls on its own. What it does is identify medicine-related risk factors clearly enough for your family member’s GP to act on, alongside everything else a proper falls assessment considers.
When is it worth raising this with a GP?
You don’t need a fall to have already happened. If your family member has become noticeably less steady, feels dizzy standing up, has had a near-miss, or takes several medicines from the categories above, especially after a recent change, that’s a reasonable moment to ask their GP about a review. If a fall has already happened, it’s worth raising sooner rather than later, alongside whatever other assessment their GP recommends. For a broader look at the everyday signs a medicine list might be worth reviewing, see our article on signs your parent may be on too many medicines.
Medicines are only one part of a falls assessment. Vision, footwear, home hazards, strength and balance all matter too, and your family member’s GP may involve a physiotherapist or other specialists alongside a medication review.1 A Home Medicines Review is arranged through their GP and funded by the Australian Government’s Community Pharmacy Programs, at no cost to your family.4 If you’re not sure whether the number of medicines involved is itself worth flagging, our article on polypharmacy explains when that becomes relevant.
Not sure what to do next?
Tell me what’s going on with your family member’s medicines — I’ll call you back, usually the same day, and we’ll work out the next step together. No cost, no obligation.
References
- RACGP, Aged care clinical guide (Silver Book), 5th edition — Part A. Falls: racgp.org.au
- healthdirect, Older people and falls — causes, treatments and prevention: healthdirect.gov.au
- healthdirect, Home medicines review: healthdirect.gov.au
- Pharmacy Programs Administrator, Home Medicines Review: ppaonline.com.au