Medications can be lifesaving and are an important part of chronic disease management for many of us. Yet certain classes of medications can contribute to falls, a leading cause of injury and death among older adults.¹

Many falls are associated with the use of fall risk-increasing drugs (FRIDs), such as sedative hypnotics, opioids, antidepressants, anticholinergics (e.g., antihistamines and muscle relaxants), and other medications that can affect balance, cognition, and alertness.^2-4 Most patients who seek medical treatment for a fall-related injury have an active prescription for at least one FRID.⁵

How can deprescribing help prevent older adult falls?

Deprescribing is the systematic process of identifying and discontinuing medications where existing or potential harm outweigh existing or potential benefits. It’s a key strategy for reducing medication-related harm in older adults.

Research teams from the University of Washington, University of Iowa, and University of North Carolina, and researchers from the Canadian Medication Appropriateness and Deprescribing Network collaborated with the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, to develop comprehensive talking points for clinicians to initiate conversations with patients about deprescribing FRIDs.

Healthcare Professional Talking Points for Adjusting Fall-Related Medications aims to enhance communication and support shared decision-making. The use of tapering schedules, patient monitoring plans, and follow-up protocols are emphasized to minimize withdrawal effects and ensure patient safety throughout the deprescribing process.

The group also developed seven patient empowerment brochures to guide the deprescribing of major categories of FRIDs. Each brochure provides patient-friendly information about the medication class, its potential impact on falls risk, and specific steps that patients can take. Topics covered include:

• Recognizing potential side effects
• Knowing when to ask about alternatives
• Understanding the tapering process
• What to expect during and after deprescribing

Deprescribing is most successful when part of multifactorial falls prevention strategies that address falls prevention exercise, environmental assessment and modifications, and other modifiable falls risk factors.⁶ By facilitating medication optimization as part of comprehensive falls prevention efforts, these resources have the potential to mitigate the negative effects of FRIDs and improve patient safety and quality of life.

Deprescribing resources

• Healthcare Professional Talking Points for Adjusting Fall-Related Medications
• Patient Empowerment Brochure: Antihistamines
• Patient Empowerment Brochure: Antipsychotics
• Patient Empowerment Brochure: Gabapentin/Pregabalin
• Patient Empowerment Brochure: Muscle Relaxants
• Patient Empowerment Brochure: Opioids
• Patient Empowerment Brochure: Tricyclic Antidepressants
• Patient Empowerment Brochure: Sedatives

Sources

1. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) National Center for Injury Prevention and Control. 2023. Found on the internet atwww.wisqars.cdc.gov

2.  Seppala LJ, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. Journal of the American Directors Association. April 2018. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/29402646/

3. de Vries M, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs. Journal of the American Directors Association. April 2018. Found on the internt at https://pubmed.ncbi.nlm.nih.gov/29396189/

4. Seppala LJ, et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others. Journal of the American Directors Association. April 2018.  Found on the internet at https://pubmed.ncbi.nlm.nih.gov/29402646/

5. Hart LA, et al. Use of Fall Risk-Increasing Drugs Around a Fall-Related Injury in Older Adults: A Systematic Review. Journal of the American Geriatric Society. June 2020. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/32064594/

6. Colon-Emeric CS, et al. Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review. Journal of the American Medical Association. April 2024. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/38536167/