Almost two-thirds of falls among people aged 65 years and older occur in those who took at least one high-risk medication in the 24 hours before the fall, according to research in the Journal of the American Geriatrics Society.

The study also found that inappropriate doses suggested by electronic prescription systems might contribute to the problem.

Authors from New York reviewed 328 falls in 287 people (average age 78.6 years). Sixty-two per cent of falls occurred in individuals administered at least one high-risk medication in the 24 hours before the fall.

Opiates were administered before 32 per cent of falls, benzodiazepines or benzodiazepine-receptor agonists (BRAs) before 20 per cent, non-benzodiazepine sleep medicines before 20 per cent, antipsychotics before 11 per cent and muscle relaxants before 3 per cent.

Sixteen per cent of falls involved individuals receiving two high-risk medications. Another 16 per cent occurred in individuals receiving three or more high-risk medications.

In addition, high-risk medications were often prescribed at doses higher than that recommended for older people. For example, 43 per cent of the 23 patients who fell after taking zolpidem received higher than recommended doses as did 57 per cent of the 51 patients who fell after taking benzodiazepines and BRAs, and 67 per cent of the nine falls while taking muscle relaxants.

The authors found that the default doses in the study hospital’s electronic prescribing system were higher than recommended for elderly adults for 41 per cent of the high-risk drugs (e.g. the default dose for tramadol was double that recommended; that for baclofen three times higher and clonazepam four times higher).

“Before the widespread use of electronic prescribing, physicians had to consciously determine the appropriate drug dosage for an individual,” says author Dr Rosanne Leipzig from Mount Sinai Hospital. “This study highlights that with electronic prescribing, default doses do matter and lowering defaults for vulnerable patient groups, such as the elderly, may be an easy way to reduce inappropriate use of high-risk drugs for these patients.”

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