Skip to main content
SpringerLink
Log in

Drug Treatment as a Cause of Falls in Old Age

A Review of the Offending Agents

  • Review Article
  • Adverse Effects
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Summary

There are a number of ways in which drugs might increase the risk of an elderly person falling. The most important of these are sedation, impaired balance and reaction time, hypotension and drug-induced Parkinson’s disease. Demonstrating the association between drugs and falls has been difficult because of certain methodological problems. However, there is now strong evidence that the use of psychotropic drugs, with the possible exception of short-acting benzodiazepines and hypnotics, is associated with a clinically important increase in the risk of falling. This increased risk is present after controlling for confounding factors such as confusion and depression. The evidence linking other drug groups to an increased risk of falls is conflicting. Decreasing the risk of drug-induced falls requires both careful individual adjustment of therapy and also a public health programme to ensure safe drug prescribing for older people.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ayd FJ. A survey of drug-induced extrapyramidal reactions. Journal of the American Medical Association 175: 1054–1060, 1961

    Article  PubMed  CAS  Google Scholar 

  • Bastow MD, Rawlings J, Allison SP. Undernutrition, hypothermia and injury in elderly women with fractured femur, an injury response to altered metabolism? Lancet 1: 143–146, 1983

    Article  PubMed  CAS  Google Scholar 

  • Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SBJ, et al. Falls by elderly people at home: prevalence and associated factors. Age and Ageing 17: 365–372, 1988

    Article  PubMed  CAS  Google Scholar 

  • Briggs RS, Castleden CM, Kraft CA. Improved hypnotic treatment using chlormethiazole and temazepam. British Medical Journal 1: 601–604, 1980

    Article  Google Scholar 

  • Brocklehurst JC, Exton-Smith AN, Lempert Barber SM, Palmer MK. Barbiturates and fractures. British Medical Journal 2: 699, 1977

    Article  Google Scholar 

  • Brynskov J, Thyssen H, Jansen E, Munster-Swendsen L. Cimetidine and Romberg’s test. Lancet 1: 1421, 1980

    Article  PubMed  CAS  Google Scholar 

  • Caird FI, Andrews GR, Kennedy RD. Effect of posture on blood pressure in the elderly. British Heart Journal 35: 527–530, 1973

    Article  PubMed  CAS  Google Scholar 

  • Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of Gerontology Medical Sciences 44: M112–117, 1989

    CAS  Google Scholar 

  • Campbell AJ, Borrie MJ, Spears GFS, Jackson SL, Brown JS, et al. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age and Ageing 19: 136–141, 1990a

    Article  PubMed  CAS  Google Scholar 

  • Campbell AJ, Reinken J. Postural hypotension in old age: prevalence, associations and prognosis. Journal of Clinical and Experimental Gerontology 7: 163–175, 1985

    Google Scholar 

  • Campbell AJ, Reinken J, Allan BC, Martinez GS. Falls in old age: a study of frequency and related clinical features. Age and Ageing 10: 264–270, 1981

    Article  PubMed  CAS  Google Scholar 

  • Campbell AJ, Somerton DT. Benzodiazepine drug effect on body sway in elderly subjects. Journal of Clinical and Experimental Gerontology 4: 341–347, 1982

    Google Scholar 

  • Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. Journal of Clinical Epidemiology 43: 1415–1420, 1990b

    Article  PubMed  CAS  Google Scholar 

  • Campbell AJ, Spears GFS, Borrie MJ, Fitzgerald JL. Falls, elderly women and the cold. Gerontology 34: 205–208, 1988

    Article  PubMed  CAS  Google Scholar 

  • Campion EW, Avorn J, Reder VA, Olins NJ. Over medication of the low-weight elderly. Archives of Internal Medicine 147: 945–947, 1987

    Article  PubMed  CAS  Google Scholar 

  • Castleden CM, George CF, Marcer D, Hallett C. Increased sensitivity to nitrazepam in old age. British Medical Journal 282: 10–12, 1981

    Article  Google Scholar 

  • Cook PJ, Huggett A, Graham-Pole R, Savage IT, James IM. Hypnotic accumulation and hangover in elderly inpatients: a controlled double-blind study of temazepam and nitrazepam. British Medical Journal 286: 100–102, 1983

    Article  PubMed  CAS  Google Scholar 

  • Cummings SR, Nevitt MC, Kidd S. Forgetting falls: the limited accuracy of recall of falls in the elderly. Journal of the American Geriatrics Society 36: 613–616, 1988

    PubMed  CAS  Google Scholar 

  • Davie JW, Blunenthal MD, Robinson-Hawkins S. A model of risk of falling for psychogeriatric patients. Archives of General Psychiatry 38: 463–467, 1981

    Article  PubMed  CAS  Google Scholar 

  • Dick RS, Barold SS. Diltiazem-induced Parkinsonism. American Journal of Medicine 7: 95–96, 1989

    Article  Google Scholar 

  • Dimant J. Accidents in the skilled nursing facility. New York State Journal of Medicine 85: 202–205, 1985

    PubMed  CAS  Google Scholar 

  • Duncan AJ, Campbell AJ. Antidepressant drugs in the elderly: are the indications as long term as the therapy? British Medical Journal 296: 1230–1232, 1988

    Article  PubMed  CAS  Google Scholar 

  • Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. Journal of Gerontology: Medical Sciences 45: M192–197, 1990

    CAS  Google Scholar 

  • Felson DT, Kiel DP, Anderson JJ, Kannel WB. Alcohol consumption and hip fractures: the Framingham Study. American Journal of Epidemiology 128: 1102–1110, 1988

    PubMed  CAS  Google Scholar 

  • Felson DT, Slontskis D, Anderson JJ, Anthony JM, Kiel DP. Thiazide diuretics and the risk of hip fracture: results from the Framingham Study. Journal of the American Medical Association 265: 370–373, 1991

    Article  PubMed  CAS  Google Scholar 

  • Gabell A, Simons MA, Nayak USL. Falls in the healthy elderly: predisposing causes. Ergonomics 28: 965–975, 1985

    Article  PubMed  CAS  Google Scholar 

  • Glassman A, Bigger JT, Giardina EV, Kantor SJ, Perel JM, et al. Clinical characteristics of imipramine-induced orthostatic hypotension. Lancet 1: 468–472, 1979

    Article  PubMed  CAS  Google Scholar 

  • Greenblatt DJ, Allen MD. Toxicity of nitrazepam in the elderly: a report from the Boston Collaborative Drug Surveillance Program. British Journal of Clinical Pharmacology 5: 407–413, 1978

    Article  PubMed  CAS  Google Scholar 

  • Greenblatt DJ, Allen MD, Shader RI. Toxicity of high-dose flurazepam in the elderly. Clinical Pharmacology and Therapeutics 21: 355–361, 1977

    PubMed  CAS  Google Scholar 

  • Gryfe CI, Amies A, Ashley MJ. A longitudinal study of falls in an elderly population. I. Incidence and morbidity. Age and Ageing 6: 201–210, 1977

    Article  PubMed  CAS  Google Scholar 

  • Hallas J, Harvald B, Gram LF, Grodum E, Brosen K, et al. Drug related hospital admissions: the role of definitions and intensity of data collection, and the possibility of prevention. Journal of Internal Medicine 228: 83–90, 1990

    Article  PubMed  CAS  Google Scholar 

  • Howell TH. Premonitory falls. Practitioner 206: 666–667, 1971

    PubMed  CAS  Google Scholar 

  • Jackson G, Pierscianowski TA, Manon W, Condon J. Inappropriate antihypertensive therapy in the elderly. Lancet 2: 1317–1318, 1976

    Article  PubMed  CAS  Google Scholar 

  • Jansen E, Brynskov J, Thyssen H. Influence of ranitidine on postural stability. Lancet 1: 54–55, 1982

    Google Scholar 

  • Jansen EC, Wachowiak-Andersen G, Munster-Swendsen J, Eng M, Valentin N. Postural stability after oral premedication with diazepam. Anesthesiology 63: 557–559, 1985

    Article  PubMed  CAS  Google Scholar 

  • Jonsson PV, Lipsitz LA, Kelley RN, Koestner J. Hypotensive responses to common daily activities in institutionalized elderly. Archives of Internal Medicine 150: 1518–1524, 1990

    Article  PubMed  CAS  Google Scholar 

  • Kalchthaler T, Bascon RA, Quintos V. Falls in the institutionalised elderly. Journal of the American Geriatrics Society 26: 424–428, 1978

    PubMed  CAS  Google Scholar 

  • Kelsey JL, O’Brien LA, Grisso JA, Hoffman S. Issues in carrying out epidemiological research in the elderly. American Journal of Epidemiology 130: 857–866, 1989

    PubMed  CAS  Google Scholar 

  • Kirshen AJ, Cape RDT, Hayes HC, Spencer JD. Postural sway and cardiovascular parameters associated with falls in the elderly. Journal of Clinical and Experimental Gerontology 6: 291–307, 1984

    Google Scholar 

  • Klenerman L, Dobbs RJ, Weller C, Leeman AL, Nicholson PW. Bringing gait analysis out of the laboratory and into the clinic. Age and Ageing 17: 397–400, 1988

    Article  PubMed  CAS  Google Scholar 

  • Korttila K, Ghoneim MM, Jacobs L, Lakes RS. Evaluation of instrumental force platform as a test to measure residual effects of anaesthetics. Anesthesiology 55: 625–630, 1981

    Article  PubMed  CAS  Google Scholar 

  • LaCroix AZ, Wienpahl J, White LR, Wallace RB, Scherr PA, et al. Thiazide diuretic agents and the incidence of hip fracture. New England Journal of Medicine 322: 286–290, 1990

    Article  PubMed  CAS  Google Scholar 

  • Lennox IM, Williams BO. Postural hypotension in the elderly. Journal of Clinical and Experimental Gerontology 2: 313–328, 1980

    Google Scholar 

  • Lipsitz LA, Nyquist RP, Wei JY, Rowe JW. Postprandial reduction in blood pressure in the elderly. New England Journal of Medicine 309: 81–83, 1983

    Article  PubMed  CAS  Google Scholar 

  • Macdonald JB, Macdonald ET. Nocturnal femoral fracture and continuing widespread use of barbiturate hypnotics. British Medical Journal 2: 483–485, 1977

    Article  PubMed  CAS  Google Scholar 

  • Montamat SC, Cusack BJ, Vestal RE. Management of drug therapy in the elderly. New England Journal of Medicine 321: 303–309, 1989

    Article  PubMed  CAS  Google Scholar 

  • Morris JC, Rubin EH, Mandel SA. Senile dementia of the Alzheimer’s type: an important risk factor for serious falls. Journal of Gerontology 42: 412–417, 1987

    PubMed  CAS  Google Scholar 

  • Morse JM, Prowse MD, Morrow N, Federspeil G. A retrospective analysis of patient falls. Canadian Journal of Public Health 76: 116–118, 1985

    CAS  Google Scholar 

  • Murphy J, Isaacs B. The post-fall syndrome. Gerontology 28: 265–270, 1982

    Article  PubMed  CAS  Google Scholar 

  • Myers MG, Kearns PM, Kennedy DS, Fisher RH. Postural hypotension and diuretic therapy in the elderly. Canadian Medical Association Journal 119: 581–584, 1978

    PubMed  CAS  Google Scholar 

  • Nayak USL, Gabell A, Simons MA, Isaacs B. Measurement of gait and balance in the elderly. Journal of the American Geriatrics Society 30: 516–520, 1982

    PubMed  CAS  Google Scholar 

  • Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls. Journal of the American Medical Association 261: 2663–2668, 1989

    Article  PubMed  CAS  Google Scholar 

  • Overstall PW, Exton-Smith AN, Imms FJ, Johnson AL. Falls in the elderly related to postural imbalance. British Medical Journal 1: 261–264, 1977

    Article  PubMed  CAS  Google Scholar 

  • Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age and Ageing 10: 141–146, 1981

    Article  PubMed  CAS  Google Scholar 

  • Rajput AH, Offord KP, Beard M, Kurland LT. Epidemiology of Parkinsonism: incidence, classification, and mortality. Annals of Neurology 16: 278–282, 1984

    Article  PubMed  CAS  Google Scholar 

  • Ray WA, Griffin MR, Downey W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. Journal of the American Medical Association 262: 3303–3307, 1989a

    Article  PubMed  CAS  Google Scholar 

  • Ray WA, Griffin MR, Downey W, Melton L. Long-term use of thiazide diuretics and risk of hip fracture. Lancet 1: 687–690, 1989b

    Article  PubMed  CAS  Google Scholar 

  • Ray WA, Griffin MR, Schaffner W, Baugh DK, Melton LJ. Psychotropic drug use and the risk of hip fracture. New England Journal of Medicine 316: 363–369, 1987

    Article  PubMed  CAS  Google Scholar 

  • Reidenberg MM, Levy M, Warner H, Coutinho CB, Schwartz MA, et al. Relationship between diazepam dose, plasma level, age and central nervous system depression. Clinical Pharmacology and Therapeutics 23: 371–374, 1978

    PubMed  CAS  Google Scholar 

  • Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, et al. Predictors of falls among elderly people. Archives of Internal Medicine 149: 1628–1633, 1989

    Article  PubMed  CAS  Google Scholar 

  • Rubenstein LZ, Robbins AS, Josephson KR, Schulman BC, Osterweil D. The value of assessing falls in an elderly population: a randomized clinical trial. Annals of Internal Medicine 113: 308–316, 1990

    PubMed  CAS  Google Scholar 

  • Sehested P, Severin-Nielsen T. Falls by hospitalised elderly patients: causes, prevention. Geriatrics 32: 101–108, 1977

    PubMed  CAS  Google Scholar 

  • Sharma JC, MacLennan WJ. Causes of ataxia in patients attending a falls laboratory. Age and Ageing 17: 94–102, 1988

    Article  PubMed  CAS  Google Scholar 

  • Sobel KG, McCart GM. Drug use and accidental falls in an intermediate care facility. Drug Intelligence and Clinical Pharmacy 17: 539–542, 1983

    PubMed  CAS  Google Scholar 

  • Sorock GS, Shimkin EE. Benzodiazepine sedatives and the risk of falling in a community-dwelling elderly cohort. Archives of Internal Medicine 148: 2441–2444, 1988

    Article  PubMed  CAS  Google Scholar 

  • Stegman MR. Falls among elderly hypertensives — are they iatrogenic? Gerontology 29: 399–406, 1983

    Article  PubMed  CAS  Google Scholar 

  • Stephen PJ, Williamson T. Drug-induced Parkinsonism in the elderly. Lancet 2: 1082–1083, 1984

    Article  PubMed  CAS  Google Scholar 

  • Swift CG, Haythorne JM, Clarke P, Stevenson IH. The effect of ageing on measured responses to single doses of oral temazepam. British Journal of Clinical Pharmacology 11: 413P–414P, 1981

    Google Scholar 

  • Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society 34: 119–126, 1986

    PubMed  CAS  Google Scholar 

  • Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Journal of Gerontology: Psychological Sciences 45: P239–P243, 1990

    CAS  Google Scholar 

  • Tinetti ME, Speechley M. Prevention of falls among the elderly. New England Journal of Medicine 320: 1055–1059, 1989

    Article  PubMed  CAS  Google Scholar 

  • Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New England Journal of Medicine 319: 1701–1707, 1988

    Article  PubMed  CAS  Google Scholar 

  • Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine 80: 429–434, 1986

    Article  PubMed  CAS  Google Scholar 

  • Vetter NJ, Ford D. Anxiety and depression scores in elderly fallers. International Journal of Geriatric Psychiatry 4: 159–163, 1989

    Article  Google Scholar 

  • Waller JA. Falls among the elderly — human and environmental factors. Accident Analysis and Prevention 10: 21–33, 1978

    Article  Google Scholar 

  • Wells BG, Middleton B, Lawrence G, Lillard D, Safarik J. Factors associated with the elderly falling in intermediate care facilities. Drug Intelligence and Clinical Pharmacy 19: 142–145, 1985

    PubMed  CAS  Google Scholar 

  • Wickham C, Cooper C, Margetts BM, Barker DJP. Muscle strength, activity, housing and the risk of falls in elderly people. Age and Ageing 18: 47–51, 1989

    Article  PubMed  CAS  Google Scholar 

  • Wild D, Nayak USL, Isaacs B. How dangerous are falls in old people at home? British Medical Journal 282: 266–268, 1981

    Article  PubMed  CAS  Google Scholar 

  • Wolfson LI, Whipple R, Amerman P, Kleinberg A. Stressing the postural response. Journal of the American Geriatrics Society 34: 845–850, 1986

    PubMed  CAS  Google Scholar 

  • Wollner L, McCarthy ST, Soper NDW, Macy DJ. Failure of cerebral autoregulation as a cause of brain dysfunction in the elderly. British Medical Journal 1: 117–118, 1979

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, University of Otago Medical School, PO Box 913, Dunedin, New Zealand

    A. John Campbell (Professor of Geriatric Medicine, Chairman)

Authors
  1. A. John Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campbell, A.J. Drug Treatment as a Cause of Falls in Old Age. Drugs & Aging 1, 289–302 (1991). https://doi.org/10.2165/00002512-199101040-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199101040-00005

Keywords

Search

Navigation