Why Are More Older People Dying After Falls?

For a while, walking on the dog was dangerous.

Earl Vickers was used to taking Molly, her shepherd-boxing-something mixture, to walk on the beach or in his neighborhood in Seaside, California. A few years ago, however, he started to feel problems standing.

“If another dog came to us, each time, I would find myself on the ground,” recalls Vickers, 69, retired electrician engineer. “It seemed like I was falling every two months. It was a bit crazy. “

Most of these tubs did not do any serious damage, although he fell back and hit his head on a wall behind him. “I don’t think I had a concussion, but that’s not something I want to do every day,” said Vickers, with regret. Another time, trying to break a fall, he broke two bones in his left hand.

Thus, in 2022, he said to the oncologist who had treated him for prostate cancer that he wanted to stop the cancer medication he had taken, out of time, for four years: Enzalutamide (sold like Xtandi).

Among the listed side effects of the drug are higher rates of falls and fractures in patients who took it, compared to those who have given a placebo. His doctor agreed that he could interrupt the drug and “I haven’t had a single fall since,” said Vickers.

Public health experts warned against the dangers of falls for the elderly for decades. In 2023, the last year of Centers for Disease Control and Prevention data, more than 41,000 Americans over 65 died from Falls, said an opinion article in Jama Health Forum last month.

More surprising than this figure, however, was another statistic: mortality linked to falling in the elderly has climbed heavily.

The author, Thomas Farley, epidemiologist, reported that the mortality rates of falling injuries in Americans over 65 had more than tripled over the past 30 years. Among those over 85, the most risky cohort, the mortality rates of falls increased to 339 per 100,000 in 2023, against 92 per 100,000 in 1990.

The culprit, in his opinion, is the dependence of Americans with regard to prescription drugs.

“The elderly are strongly medicated, more and more, and with inappropriate drugs for the elderly,” said Farley in an interview. “It did not happen in Japan or in Europe.”

However, this same 30 -year period saw a burst of research and activity to try to reduce geriatric falls and their potentially devastating consequences, hip fractures and brain bleeding with limited mobility, persistent pain and institutionalization.

The American Gériatrics Society adopted updated guidelines for fall prevention in 2011. The CDC unveiled a program called Steadi in 2012. The United States preventive service working group recommended the exercise or physiotherapy for the elderly at risk of falling in 2012, 2018, and again last year.

“There have been studies and interventions and investments, and they were not particularly successful,” said Donovan Maust, a geriatric psychiatrist and researcher at the University of Michigan. “It’s a bad problem that seems to get worse.”

But do prescription drugs lead this increase? The Gerietricians and others looking for falls and prescription of practices question this conclusion.

Farley, a former New York Health Commissioner who teaches at the University of Tulane, has recognized that many factors contribute to falls, including physical disabilities and the deterioration of sight associated with the age of advancement; Alcohol abuse; And stumble the dangers in people’s houses.

But “there is no reason to think that one of them has worsened three times in the past 30 years,” he said, pointing to studies showing reductions in other high-income countries.

The difference, he believes, is the growing use of drugs by Americans – such as benzodiazepines, opioids, antidepressants and gabapentine – which act on the central nervous system.

“The drugs that increase the mortality of falls are those that make you sleep or dizzy,” he said.

Problematic drugs are numerous enough to have acquired an acronym: Frids or “increasing drugs of the fall”, a category which also includes various early heart and antihistamic drugs like Benadryl.

These drugs play a major role, agreed Thomas Gill, geriatrician and epidemiologist at the University of Yale and a long -standing researcher. But, he said, “there are alternative explanations” for the increase in mortality rates.

He cited changes in the declaration of the causes of death, for example. “Years ago, falls were considered a natural consequence of aging and no serious,” he said.

Death certificates have often attributed deaths among the elderly to evils such as heart failure instead of falls, which means that the mortality of falls appeared lower in the 80s and 1990s.

The cohort of more than 85 years of today can also be more fragile and more sick than the oldest age was 30 years ago, added Gill, because contemporary medicine can keep people life longer.

Their accumulated deficiencies, more than the drugs they take, could make them more likely to die after a fall.

Another skeptic, Neil Alexander, geriatrician and falls of falls at the University of Michigan and the health system will Ann Arbor, argued that most doctors ended up understanding the dangers of Frids and prescribing them less often.

“Message delivered,” he said. Since alarms have sounded on opioids, benzodiazepines and related drugs, and in particular opioids and benzos together, “many primary care physicians have heard the gospel,” he said. “They know not to give the elderly Valium.”

In addition, the prescriptions for certain drugs related to the fall have already decreased or reached trays, even if the mortality rates due to the falls have increased. Medicare data show a lower prescription opioids from a decade ago, for example. Benzodiazepine prescriptions for elderly patients have slowed down, said Maust.

On the other hand, the use of antidepressants and gabapentine has increased.

Whether the use of drugs prevails or not all other factors, “no one disputes that these agents are overused and used inappropriately” and contribute to the disturbing increase in mortality rates in the elderly, said Gill.

Thus, the current campaign for “depreses” – stopping drugs whose potential damages prevail over their advantages or reduce their dosage.

“We know that many of these drugs can increase falls by 50 to 75%” in older patients, said Michael Steinman, geriatrician at the University of California-San Francisco and co-director of the American depression research network, created in 2019.

“It’s easy to start medication, but it often takes a long time and efforts to stop taking them,” he said. Haid doctors can pay less attention to therapeutic patterns than to health problems that seem more urgent, and patients can be reluctant to abandon pills that seem to help in pain, insomnia, reflux and other age -related current complaints.

Beer criteria, a repertoire of drugs often deemed unacceptable to the elderly, have recently published recommendations for alternative drugs and non -pharmacological treatments for frequent problems. Cognitivo-behavioral therapy for insomnia. Exercise, physiotherapy and psychological interventions for pain.

“It is a real tragedy when people have this event that changes their life,” said Steinman, co -president of the Beers on alternatives, about Falls. He urged older patients to raise the question of the Frids themselves, if their doctors have not done so.

“Ask,” Does one of my medication increase the risk of falls? ” Is there another treatment? “, He suggested. “Being an informed patient or caregiver can put this on the agenda. Otherwise, it might not appear. “

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