Pills, Spills, and Broken Hips

by Richard P. Holm, MD
 
As a kid in country school, she ran faster than others, fell a lot, always picked herself up, and knee scabs were part of her story. Now in her 80s, she’s been falling again, especially after medications for a leaky bladder, blood pressure, and pain were started.
 
Last night she fell in the bathroom, couldn’t get up, and remained there until the neighbor checked on her this afternoon. The hip was broken, and after repair and recovery time in the hospital, she moved to the nursing home.
 
More than one-third of Americans older than 65 experience at least one fall, every year, with nearly two million of these people ending up in the emergency room. Once in the ER, 60% have a fracture of some kind, and 9% have head trauma. Falls in the elderly can cause many problems, most commonly fractured backs, wrists, hips and arms, as well as brain damage. The mean age of those visiting the ER for falls is 79, 76% are women, and more than 300,000 people with hip fractures need major surgery every year. These injuries cost our society billions of dollars every year, not to mention the physical and emotional cost to the individual who has to endure the pain and disability from an accident.
 
Falls are caused in the elderly because of many reasons. Older people have slower reflexes, balance problems, reduced muscle strength, poorer vision, and are more often plagued by any generalized illness. Too often elderly people are not exercising or active, resulting in a softening of the skeletal structure and a higher risk for fracture. The risk of stumbling and falling increases in the presence of loose rugs, cluttered floors, poor lighting, exposed electrical or telephone cords, and stairs without handrails.
 
Probably the most alterable risk factor is the medication list. More than 20% of people over 55 years of age are taking more than four prescription medications, and it only goes up with age. The worst fall inducing culprits include gabapentin-like meds, benzo-type sleeping/anxiety pills, digoxin, narcotics, diuretics, and meds for urinary incontinence, high blood pressure, heart, and prostate. Well-meaning care providers sometimes add meds to every new complaint and can forget to take away the old ones. Falling risks multiply with too many drugs!
 
It is imperative that any patient or family member push the doctor for less, not more, meds. Pills can cause spills and broken hips.