For Earl Vickers, taking his dog for a walk turned into quite a challenge. What used to be a relaxing stroll along the beach or through his Seaside, California neighborhood became a source of difficulty for him: he began to have trouble keeping his balance.
“If another dog came toward us, every single time I’d end up on the ground,” the 69-year-old retired electrical engineer told The New York Times. “It seemed like I was falling every other month. It was kind of crazy.”
Mr. Vickers has had his fair share of tumbles over the years, but luckily, most incidents didn’t result in anything too serious. However, one particular fall left a mark—literally. He fell backward and struck his head against a wall, an experience that made him pause to reflect on the fragility of his situation. “I don’t think I had a concussion, but it’s not something I want to do every day,” he admitted with a hint of humor.
Another mishap occurred when he attempted to brace himself during a fall, resulting in two broken bones in his left hand. Those events undoubtedly took a toll, both physically and mentally.
In 2022, he made a pivotal decision regarding his health care. After four years of on-and-off treatment with enzalutamide, a drug prescribed for his prostate cancer, he expressed to his oncologist his desire to discontinue its use. It was a choice not made lightly, but given the drug’s known side effects, which included an increased risk of falls and fractures, something he had experienced firsthand, to his relief, his doctor agreed to his request.
Ever since, he has noticed a remarkable change.
“I haven’t had a single fall since,” he proudly shared.
Public health experts have been sounding the alarm about the dangers of falls for older adults for decades now, and for good reason. According to reporting by The Times, in 2023, the most recent year of data from the Centers for Disease Control and Prevention (C.D.C.), more than 41,000 Americans over 65 died from falls, an opinion article in JAMA Health Forum pointed out last month. Even more alarming is that this number is just a piece of a larger puzzle; fall-related mortality among older adults has been climbing sharply, raising serious concerns about the safety and well-being of our aging population.
Dr. Thomas Farley, an epidemiologist and former New York City health commissioner who teaches at Tulane University, has raised some serious concerns about this disturbing rise. His research shows that over the past 30 years, these rates have skyrocketed, especially for those over 85, the group that’s facing the highest risk. In 2023, the death rate from falls in this age bracket hit a staggering 339 per 100,000, a dramatic increase from just 92 per 100,000 back in 1990.
Dr. Farley points the finger at the growing reliance on prescription drugs among older people.
“Older adults are heavily medicated, increasingly so, and with drugs that are inappropriate for older people,” he explained in an interview. “This didn’t occur in Japan or in Europe.”
In the last 30 years, however, there has been a notable increase in research and programs focused on preventing falls among older folks. Falls can lead to serious issues like hip fractures, brain injuries, loss of mobility, chronic pain and even the need for nursing care.
For example, in 2011, the American Geriatrics Society updated its guidelines for preventing falls, and in 2019, the C.D.C. launched the STEADI program to help older people manage their risk of falling. In addition, the United States Preventive Services Task Force has repeatedly recommended exercise or physical therapy for seniors at risk of falls in 2012, 2018 and last year. However, Dr. Donovan Maust, a geriatric psychiatrist and researcher at the University of Michigan, notes that the outcomes haven’t been very promising. He calls out, “There’ve been studies and interventions and investments, and they haven’t been particularly successful. It’s a bad problem that seems to be getting worse.”
Dr. Farley brings another important point. He suggests that while factors like physical impairments and poor eyesight are contributors to falls, they alone can’t explain the remarkable rise we’ve seen in the past few decades. He argues that when we take into account these issues along with risks like alcohol misuse and tripping hazards in the home, “there’s no reason to think any of them have gotten three times worse in the past 30 years.”
Instead, he attributes the shift to the growing reliance on medications that affect the central nervous system like benzodiazepines, opioids, antidepressants and gabapentin. These drugs, while often necessary for managing pain or mental health issues, can greatly impair balance and coordination, making falls more likely.
Farley’s observations also echo findings from other high-income countries, where conversely, similar medication use hasn’t led to a comparable spike in fall-related injuries. He says this indicates that perhaps the way Americans typically approach medication and health management is what plays a key role.
“The drugs that increase falls’ mortality are those that make you drowsy or dizzy,” he said.
As stated in the Jama Health Forum, there are many problematic drugs known as FRIDs, or Fall-Risk-Increasing Drugs, which include certain cardiac medications and early antihistamines like Benadryl. These drugs can impair balance and cognition, increasing fall risk among older adults, particularly the frail.
Dr. Thomas Gill, a geriatrician at Yale, recognizes the escalating death rates among seniors over 85, but he also notes that while FRIDs contribute to fall risk, other factors are contributing as well. He calls out that historical reporting of death causes has changed: “Years ago, falls were considered a natural consequence of aging and no big deal,” he told The Times, describing how in the past, deaths and how they were noted on death certificates, were linked to more serious conditions like heart failure, which made the number of those dying from falls seem smaller in the 1980s and 1990s.
Dr. Gill also notes that today’s seniors over 85 are more fragile and face more chronic health issues than those from three decades ago. This is because although medical advancements have extended life, they often come with more health challenges, leading to poorer recovery outcomes after falls.
Dr. Neil Alexander, a geriatrician and falls expert at the University of Michigan and V.A. Ann Arbor Healthcare System, agrees. He says that more doctors are recognizing the risks these drugs pose, especially for older patients at higher fall risk. And as a result, there’s been a significant drop in prescriptions, with doctors now seeking safer alternatives.
“A lot of primary care doctors have heard the gospel,” he said. “They know not to give older people [benzodiazepines and related drugs such as] Valium.”
With this in mind, while some fall-related drug prescriptions have decreased or stabilized, fall-related death rates among seniors are increasing anyway. Medicare data reveals a significant reduction in opioid prescriptions over the last decade and a slowdown in benzodiazepine use, according to Dr. Maust. Still, the use of antidepressants and gabapentin has risen, prompting concerns about their overall effects. Dr. Gill points out that many of these medications are overprescribed and often misused, seriously contributing to the rising fall-related fatalities among the elderly. This has sparked a movement advocating for “de-prescribing,” which involves stopping or reducing medications that pose more risks than benefits. Dr. Michael Steinman, a geriatrician and co-director of the US Deprescribing Research Network, notes that many of these drugs can increase fall risk by 50% to 75% in older patients.
“It’s a real tragedy when people have this life-altering event,” said Dr. Steinman, who co-chairs the panel for the Beers Criteria, a list of medications that are generally considered unsuitable for older adults, in an interview with The Times – they’ve recently published recommendations for alternative medications and nonpharmacological treatments for frequent problems. He encouraged older patients to bring up the topic of fall risk-increasing drugs (FRIDs) with their doctors if they haven’t discussed it already.
“Ask, ‘Do any of my medications increase the risk of falls? Is there an alternative treatment?’” he recommends.
“Being an informed patient or caregiver can put this on the agenda. Otherwise, it might not come up.”
