For a while, walking on the dog has become dangerous.
Earl Vickers used to get Molly, her mixture of German shepherd dogs, boxer and something else, walking the beach or his neighborhood in Seaside, California.
However, a few years ago, he started to have problems.
“Each time another dog came to us, it ended on the ground,” said Vickers, 69, retired electronic engineer. “It seemed like I fell every two months. It was crazy.”
Most of these falls did not cause serious damage, although he fell on his back and hit his head against a wall.
“I don’t think I have a shock, but that’s not something you want to have every day,” said Vickers with irony. On another occasion, when you try to stop a fall, two bones fractured with the left hand.
Thus, in 2022, he told the oncologist that he had treated him for prostate cancer that he wanted to stop taking the medication he had used, intermittently, for four years: Enzalutamide (sold under the trade name of Xtandi).
Among the side effects attributed to this drug are higher rates of falls and fractures in patients who use it, compared to those who receive a placebo. His doctor agreed to suspend the treatment and, according to Vickers, “I have not fallen again since then.”
Public health experts have taken the dangers that fall for the elderly for decades.
In 2023, the last year with available data from Centers for Disease Control and Prevention (CDC), more than 41,000 people over 65 years old died of falls, according to an opinion article published in August in August in August in August in August in August in August in August in August in August in August in August Jama Health Forum.
But more surprising than this figure is another fact: mortality linked to falls in the elderly has increased in a pronounced manner.
The author of the article, Thomas Farley, epidemiologist, reported that mortality rates due to injury -related injuries in people over 65 had tripled in the past 30 years. In the group over 85 – the highest risk – the mortality rate due to the fall increased from 92 per 100,000 people in 1990, to 339 per 100,000 in 2023.
According to his opinion, the culprit is the dependence of prescription drugs.
“The elderly are very medicated, more and more and with drugs that are not suitable for their age,” said Farley in an interview. “It did not happen in Japan or in Europe.”
And that during this same period of 30 years, there was an avalanche of research and actions to reduce falls in the elderly and their potentially devastating consequences, such as hip fractures, brain hemorrhages, loss of mobility, persistent pain and even institutionalization.
The American Society of Gariatrics updated its fall prevention guides in 2011. The CDC launched a program called Steadi in 2012. The United States Preventive Services Working Group recommended in 2012, 2018 and again last year that the elderly at risk exercise or receive physiotherapy.
“Studies, interventions, investments have been carried out and have not been particularly successful,” said Donovan Maust, a geriatric psychiatrist and researcher at the University of Michigan. “It’s a serious problem that seems to increase.”
But do prescription drugs cause this increase? Geriatricians and other experts studying falls and prescription practices doubt this conclusion.
Farley, a former New York Health Commissioner and Current Professor at the University of Tulane, has recognized that many factors contribute to falls: physical deterioration, vision loss with age, alcohol consumption and home dangers.
But, I add that “there is no reason to think that some of these factors have worsened three times in the past 30 years”, and indicates studies that show a decrease in other high -income countries.
The difference, he said, is the growing use of drugs in the United States-such as benzodiazepines, opioids, antidepressants and gabapentine-which affect the central nervous system.
“The drugs that increase mortality due to falls are those that make you feel asleep or dizzy,” he said.
There are so many problematic drugs that even have an acronym: Frids, by their name in English “drug drugs at risk of autumn” (drugs that increase the risk of falls). This category also includes certain heart medications and the first antihistamines, such as Benadryl.
These remedies play an important role, Thomas Gill, Gériatra and epidemiologist at the University of Yale, agree with years of experience investigating the falls. But he also said that “there are other explanations” possible for the increase in mortality rates.
He mentioned, for example, changes in the way the causes of death are reported. “Years ago, falls were considered a natural consequence of aging, unimportant,” he said.
Death certificates have often attributed the cause to illnesses such as heart failure, not a fall, which made the drop in mortality seems lower in the 1980s and 1990s.
Gill added that people over 85 could be more fragile and more sick than those of 30 years ago, because current medicine allows life to prolong.
Their multiple diseases could make them more likely to die after a fall, more than the drugs they take.
Another skeptic, Neil Alexander, geriatrician and fall in falls at the University of Michigan and to the Veteran Health System in Ann Arbor, argued that most doctors already understood the risks of Frids and the least recipe.
“The message has arrived,” he said. Given the level of alarm that has been on opioids, benzodiazepines and in particular the combined use of the two “, many primary care physicians have already heard the sermon,” he said. “They know that they should not prescribe valium for the elderly.”
In addition, the recipes of some of these drugs have decreased or stabilized, while falling deaths continued to increase. For example, Medicare data show that the use of prescription opioids began to drop a decade ago. The prescription of benzodiazepines in elderly patients has also slowed down, according to Maust.
However, on the other hand, the use of antidepressants and gabapentine has increased.
Whether or not the main factor is the main factor, “nobody discusses that these drugs are used in excess and inappropriately,” said Gill, and that they contribute to the disturbing increase in deaths due to falls in the elderly.
Hence the current campaign in favor of “discomfort”: to suspend drugs whose possible damage exceeds the advantages, or at least reduce their dose.
“We know that many of these drugs can increase falls by 50 to 75%” among the elderly, said Michael Steinman, Gériatrica at the University of California in San Francisco and the co-director of US Depress Reward Research Network, created in 2019.
“It’s easy to start medication, but several times you need a lot of time and efforts to leave them,” he said. Doctors, employees, can pay less attention to the drug diet than to other more urgent health problems, and patients tend to leave drugs that help them with pain, insomnia, reflux and other common age problems.
Los Beer criteriaA directory of drugs considered to be little advised for the elderly, recently published recommendations on alternative drugs and non-pharmacological treatments for common problems: cognitive-behavioral therapy for insomnia; Exercise, physiotherapy and psychological interventions for pain.
“It is a real tragedy when people live an event that changes their life in this way,” said Steinman, who also presides over the panel of the panel Beer criteria on alternative treatments.
He recommended the elderly to speak to their doctors of Frids if they do not mention it.
“Ask:” One of my drugs increases the risk of falls? Is there alternative treatment? “”, He suggested. “Being informed, whether as a patient or as a caregiver, can help the subject to touch. Otherwise, he may not even be mentioned.”
The new old age It is a production in collaboration with The New York Times.
