The older we get, the frailer we get. We also lose strength and our sense of balance. All of those contribute to a greater likelihood that we’ll fall, which can be a life-ending event for many elderly people. Although fitness training can help older people maintain some strength and balance, certain medications can offset our efforts to remain upright.
According to a recent study in the Journal of the American Geriatrics Society, serious falls are more than twice as likely in older men who take medicines with anti-cholinergic properties. Such drugs, including over-the-counter varieties, often are prescribed for older people with bladder problems, depression, psychosis, insomnia and respiratory problems, among other disorders. Some of their common brand names (with the generic in parentheses) include:
- Elavil (amitriptyline)
- Actifed (chlorpheniramine)
- Clozaril (clozapine)
- Advil PM, Aleve PM, Bayer PM, Benadryl, Exedrin PM, Nytol, Sominex, Tylenol PM, Unisom (diphenhydramine)
- Zyprexa (olanzapine)
- Xanax (alprazolam)
- Zyrtec (cetirizine)
- Tagamet (cimetidine)
- Lasix (furosemide)
- Imodium (loperamide)
- Claritin (loratadine)
- Zantac (ranitidine)
(Some of these drugs aren’t classified as anti-cholinergics, but often mimic their activity.)
In addition to the dizziness, drowsiness and unsteady gait they can cause, other side effects might be dry mouth, constipation, headache, disorientation and visual difficulties.
Anticholinergics affect the brain by blocking a key chemical (acetylcholine) that assists in nerve cell communication.
The researchers analyzed data from the Irish Longitudinal Study on Ageing (TILDA) to identify the link between these medicines and falls that cause serious injury in Irish people 65 and older. Previous studies have shown an impact on cognitive function and mortality from taking multiple anti-cholinergic medicines.
Medications taken by these participants were recorded as well as the number and type of falls they had experienced. The researchers found that falls resulting in injury were more than twice as likely in men taking medicines with potent anti-cholinergic activity, even after accounting for differences in health and other fall risk factors. The greater the use of these meds, the higher the risk of falls for men.
It was interesting that there was no such association for women, a finding the researchers said warranted further study.
If you or a loved must take an anti-cholinergic medicine, make sure the doctor and/or pharmacist regularly reviews the need for it, and the dose.
Falls are a leading cause of hospitalization and home health-care, as well as the loss of independence for older people. Often after a fall, an older person never regains their quality of life.
For more information about falls and the elderly, see Patrick’s newsletter, “Standing Tall Against a Fall.”