Polypharmacy and falls risk
Polypharmacy means taking many medicines at once, and the risk of falls rises with the number of medicines taken.
Remember
The effects of medicines add up as more are taken, so the risk of falls rises; review how many medicines a patient takes and whether each is still needed.
A medicine changes how the body works, so all of its actions, both desirable and less so, can raise the risk of a fall. The effect is compounded the more medicines a patient takes. This is polypharmacy: taking many medicines at once. Each medicine added brings more side effects (the less desirable actions of a drug) and more drug-drug interactions (one medicine changing how another works), so a fall is more likely even when no single drug looks dangerous.
Common effects of medicines include dizziness, drowsiness and poor balance, as well as a drop in blood pressure on standing, called postural hypotension. Drugs that can cause drowsiness, such as analgesics and many antihistamines, can decrease a patient's awareness and increase the likelihood of falling over.
Find out what medicines any patient is on, both prescribed and over the counter. Check that they take them as prescribed and ask about any recent change. Counting the total number of regular medicines is the first step in spotting polypharmacy. A regular medication review checks whether the patient still needs each medicine, so that unnecessary medicines can be stopped or doses reduced.
Key facts
- Polypharmacy
- means taking many medicines at once, so side effects and interactions build up with each one added.
- Effects on a patient
- poor balance, dizziness, drowsiness and postural hypotension can follow.
- First step in spotting polypharmacy
- count the total number of regular medicines the patient takes.
- Ask about
- both prescribed and over-the-counter medicines, and any recent change.
- Action
- a regular medication review, so unnecessary medicines can be stopped or doses reduced.
Exam traps
- Hypertension treated with a single medicine carries less risk than many medicines, although it can still contribute to postural hypotension.
- Inhaled treatment for asthma that is well controlled has little effect on balance, blood pressure or alertness, so it is not a good example of a drug-related falls risk.
- A single long-term condition does not explain the combined effects on balance and blood pressure that come from several medicines acting together.
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