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Falls in Elderly Women Tied to Chronic Diseases

British study cites conditions, not the drugs that treat them

THURSDAY, Sept. 25, 2003 (HealthDayNews) -- Contrary to prior assumptions, when elderly women fall, it's more likely due to a chronic disease and not to the medications they're taking.

A study appearing in the Sept. 27 issue of the British Medical Journal found elderly women with chronic conditions such as arthritis or depression are at a higher risk of falling, and these conditions may account for about a third of falls in this population.

"Previously, polypharmacy [taking multiple medications] has been highlighted as important to falls. The more tablets you take, the more likely you are to fall," says study author Dr. Debbie Lawlor, a senior lecturer in epidemiology at the University of Bristol in Britain. "We found that the disease processes, rather than the drugs, are responsible."

Older people are prone to falls, some of them with devastating consequences, because a number of processes start interfering with their balance. One is peripheral neuropathy, which is when damage occurs to the peripheral nerves. Vertigo, inner ear disorders and visual disturbances also play a part.

"A number of senses come into play when we talk about why someone falls. Muscle strength is also a critical factor," says Dr. Gerard Varlotta, an associate professor of rehabilitation medicine at New York University/Rusk Institute in New York City. "Those are processes that deteriorate as we get older, and that's why the elderly are more susceptible to falling."

Many medications also cause dizziness or low blood pressure, and it has been thought that these can contribute to falls as well. What's interesting about this study, Varlotta says, is the diseases rather than the medications treating them seem to be implicated.

"It would indicate that it's the aging process," Varlotta says. "It's comforting for me as a practitioner to know that when I'm prescribing a medication, I'm not making it worse. The first rule in medicine is do no harm. If we're not knowingly putting people at risk, then we may be able to say 'OK, let's treat that more aggressively.'"

The authors of this study asked 4,050 British women between the ages of 60 and 79 how many times they had fallen during the past year and whether they had received medical attention for those falls. The study authors also collected information on different chronic diseases the participants had been diagnosed with and took a complete drug history.

About three-quarters of the women had been diagnosed with at least one chronic disease and just over 70 percent were taking at least one drug.

The authors found that of all the falls in elderly women, roughly one-third were caused by having at least one chronic disease. The risk of falling was higher if a person had circulatory disease, chronic obstructive pulmonary disease, depression or arthritis. Each additional chronic disease diagnosis was associated with about a 40 percent increased risk of falling. Chronic diseases also increased the risk of frequent falls and severe falls.

Of all total falls, 6.2 percent occur in people with coronary heart disease, 6.2 percent in people with circulatory disease, 8 percent in those with chronic obstructive pulmonary disease, 9.4 percent in those suffering depression and 17.4 percent in those with arthritis.

Some of the factors that are frequently associated with falling, such as alcohol consumption, were not associated with an increased risk of falling. This may have been due to the fact that the population in question was a female one and were not heavy drinkers, Lawlor says.

Only two types of drugs, sedatives and antidepressants, were associated with an increased risk of falling; each raised the odds by about 50 percent. In total, 2 percent to 5 percent of all falls happened in people who were taking these medications.

The findings suggest prevention and treatment of chronic disease may be the right strategy for preventing falls. "Primary prevention would be preventing the disease in the first place and then having an awareness that the person is at an increased risk of falling, and trying exercise or rehabilitation programs so they are less likely to fall," Lawlor says.

While medicines are often necessary to help control pain and other symptoms, Varlotta points to other precautions that can be taken to reduce the risk of falls: Don't climb on ladders, make sure areas are lighted, remove throw rugs, don't have a cluttered house and install lights that go on automatically at night or that have sensors to detect when someone enters a room. "Those things have been very, very much proven to prevent falls," he says.

More information

For more on falling and the elderly, visit this patient page from the Journal of the American Medical Association. The National Institute on Aging has balance and strength exercises.

SOURCES: Gerard Varlotta, D.O., associate professor, rehabilitation medicine, New York University/Rusk Institute, New York City; Debbie Lawlor, M.D., Ph.D., senior lecturer, epidemiology, Department of Social Medicine, University of Bristol, United Kingdom; Sept. 27, 2003, British Medical Journal
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