Warning sounded on common meds

Older Australians who take antidepressants or opioids more than double their likelihood of suffering falls and hip fractures, according to new research.

In a paper published in Australian Prescriber, lead authors Professor Libby Roughead and Dr Kerrie Westaway from the University of South Australia outline the impact of these drugs on older people.

According to the research, an estimated 30 per cent of Australians aged over 65 living in the community, and 50 per cent of residents in aged care facilities, fall at least once a year. An estimated 28,000 people aged over 50 were hospitalised with a hip fracture in 2018.

Researchers used data from the Australian Government Department of Veterans’ Affairs (DVA) in a matched case-control study, comparing 8828 veterans with hip fractures with 35,310 people of the same age and gender, examining their medicine use in the previous six months. The average age of the cohort was 88 and 63 per cent were women.

Psychotropic drugs – any drug capable of affecting the mind, emotions and behaviour – are used to treat a wide range of conditions including depression, pain and dementia. However, they can induce side effects including drowsiness, dizziness and blurred vision – factors that increase the likelihood of falls and fractures, the researchers say.

“Antidepressants, opioids, antiepileptic medicines, benzodiazepines (used to treat anxiety) and antipsychotics all increase the risk of hip fractures,” says Prof. Roughead. “Combining them, increases the risk even further – up to five times in the case of starting antidepressants and anxiety medicines together.”

Research has found that this equates to one extra hip fracture for every 17 patients aged 80 and over who are treated for a year.

Australians are among the highest users of antidepressants in the world, with about 10 per cent of the adult population taking them daily.

“We suggest to prescribers they consider whether patients really need some of their medicines any more,” says Prof. Roughead. “For example, an SSRI antidepressant [selective serotonin reuptake inhibitor] may no longer be required if a patient is fully recovered from depression. Similarly, it may be possible to stop an antipsychotic in someone with dementia.

“Doctors should try stopping one medicine at a time, reducing it slowly over weeks or months.”

Reducing medicine use, exercising more and using other interventions such as occupational therapy and podiatry can lower this risk of falling, the researchers say.

Last year, an estimated 28,000 Australians over the age of 50 were hospitalised with a hip fracture. Of those, five per cent died in hospital and about 10 per cent were discharged to an aged care facility.

Professor Dimity Pond, a GP with a special interest in dementia and aged care, told newsGP she was not surprised by the findings.

“I think there are a lot of reasons for us to reduce the number of medications that we provide for older people, and falls [risk] is one of them,” she said.

“Then you need to balance up the benefits [of medication] against the risk.

“Fracture is no small thing in older people. It can be life changing.

“People who fracture their hip, a high percentage of them don’t get back to walking as they used to – or at all – and there’s a high mortality rate after a fracture …”

The study authors say GPs should encourage patients to work with a range of health professionals to help them stay active and socially connected, and reduce the risk of falls as a result. Exercise programs and home safety interventions can also help, they say, as can encouraging patients to report adverse effects that can increase falls risk, such as dizziness, confusion or blurred vision.

The authors also recommend that patients at risk of poor bone health be referred for a mineral-density scan.

Prof. Pond says the research highlights the “complexity of looking after older people” and shows that GPs need to spend enough time on these complex issues.

“I can’t resist saying that we need to be adequately remunerated for that time, or it won’t happen,” she added.

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Written by Janelle Ward

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