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Clinical practice algorithms: Medication management to reduce fall risk in the elderly—Part 3, benzodiazepines, cardiovascular agents, and antidepressants

There are associations between falls and the use of sedatives, psychotropics, cardiovascular agents, antidepressants, and polypharmacy (Leipzig, Cumming, & Tinetti, 1999a,b; Neutel, Perry, & Maxwell, 2002; Smith, 2003; French et al., 2006). Our third article in the series will review the development of specific subalgorithms for benzodiazepines (BZDs), cardiovascular agents, and antidepressants (algorithms 3–5). We presented the process of development in our first article and the summary algorithm (algorithms 1 and 2) in our second article in this series. There are a number of ways in which drugs might increase the risk of an elderly person falling,most common being sedation, impaired balance and reaction time, orthostatic hypotension, and drug-induced parkinsonism (Campbell, 1991; Fick et al., 2003; Seymour & Routledge, 1998). Medications are a potentially modifiable factor which can reduce fall risk (Campbell, Robertson, Gardner, Norton, & Buchner, 1999; Tinetti, 2003; Williams, 2002). The Guideline for the prevention of falls in older persons (American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel of Falls Prevention, 2001) states that patients who have fallen should have their medications reviewed and altered or stopped as appropriate in light of their risk of future falls.