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Each year, 50-75% percent of nursing home residents fall, resulting in injuries and even death. This can happen for many reasons, including the physical and mental limitations of elderly residents. Nursing homes are tasked with understanding and mitigating these risk factors.

Medication can increase the risk of falling for nursing home residents. Learn which medications are commonly associated with increased chances of falling and how to protect your loved ones.

Medications related to fall risk

Some medications can have side effects, such as dizziness, that can make a fall more likely. The following drugs are associated with an increased risk of falling:

Prescription drugs

Prescription drugs, even if properly administered, can play a role in increasing fall risk. The following are medications associated with a potentially increased risk of falling:

  • Anticonvulsants. Anticonvulsants are typically prescribed to manage seizures, but they can also be used for patients with a pattern of difficult behavior, such as those with Alzheimer’s disease. This type of medication can affect balance. Valium and Gabapentin are two well-known anticonvulsants.
  • Antidepressants. Antidepressants are a wide class of drug, including medications like SSRIs, SNRIs, MAOIs, and tricyclic antidepressants. Antidepressants, prescribed to treat depression and sometimes anxiety, can have a sedative effect. Zoloft, Prozac, and Lexapro are the brand names of some commonly prescribed antidepressants.
  • Antipsychotics. Antipsychotics, such as Risperdal, are another possible prescription for patients who suffer from Alzheimer’s disease or dementia. Antipsychotic medication can have a sedative effect, which increases the chances of a fall.
  • Blood pressure medication. Many seniors manage high blood pressure with medication, such as diuretics or beta-blockers. Blood pressure medication can cause orthostatic hypotension, a sudden drop in blood pressure when standing, which can result in a fall.
  • Benzodiazepines. Benzodiazepines, like Xanax or Ativan, can be prescribed for anxiety and insomnia. This type of medication can cause drowsiness and confusion. They can also affect coordination and vision.
  • Opioids. Drugs such as codeine, OxyContin, and Demerol belong to the opioid class of drugs. These medications are powerful painkillers. Opioids can affect motor and cognitive function.
  • Sedatives. Benzodiazepines can be prescribed as sedatives, but there are also non-benzodiazepine sedatives. These drugs, such as Ambien or Lunesta, are prescribed for insomnia. These medications make you sleepy and can affect the sense of balance.

The medical staff at a nursing home should always be aware of how prescribed medications affect fall risk for its residents.

Over-the-counter medications

Over-the-counter (OTC) medications can be taken without a doctor’s prescription, but they will have side effects and potential interactions with prescription drugs to consider. The following medications may increase fall risk:

  • Antihistamines. Antihistamines are drugs that help reduce allergy symptoms. Brands like Benadryl, Claritin, and Zyrtec are available as OTC options. Some antihistamines can make you drowsy.
  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) are OTC painkillers, such as aspirin and Advil. Dizziness may be a side effect.
  • Sleep aids. Insomnia can be treated with OTC medications like Aleve PM and Benadryl. Sleep aids can cause blurred vision and, of course, drowsiness.
  • Vitamins. Some supplements, such as vitamin D, have been shown to increase fall risk. 

Medication plan and fall prevention

It’s common for residents to be taking several different medications while living at a nursing home, so it’s important to understand the role their medication plan plays in preventing falls. A medication plan covers all medications a nursing home resident is taking, why they are taking them, and potential risks to take into account.

When medication increases a resident’s risk of falling, the nursing home should build a prevention plan by:

  • Understanding the risk. Medication is an integral part of a nursing home resident’s care plan. The nursing home needs to know which medications a resident is taking, how those medications affect fall risk, and what extra precautions to take to prevent a fall.
  • Revaluating the medication schedule. Doctors prescribe medications for a particular reason. Some medications are meant to be taken for only a short period of time, while others are long-term. Regularly reviewing medications can reduce the risk of falls.

Your loved one’s doctor can stop any medications that are no longer necessary or reduce the dosage when appropriate. Or, they can look for viable alternatives that are less likely to contribute to a fall.

  • Having a plan of care. Beyond medication, nursing homes need to have a plan of care in place to prevent falls. This means developing and enforcing safety policies that keep residents safe.

Nursing home liability in falls

Nursing homes are responsible for preventing falls even if a resident is high risk because of the medication they take.

While accidents do happen, in many instances nursing home staff negligence allows falls to happen. Nursing homes may be liable for a resident fall in the case of:

  • Medication errors. Failure to properly administer medication can significantly increase the risk of falling, among other consequences. Administering an inaccurate dose, giving the wrong drug, and not adhering to the proper time schedule are all serious medication errors.
  • Lack of proper supervision. Nursing homes are in charge of managing residents’ medication schedules, which means the facility and its staff should be aware of any medications that increase the risk of a fall. Residents need to be properly supervised so staff members can intervene and prevent falls. Understaffing or lax protocols can lead to residents being left unsupervised and at risk of a fall.
  • Improper staff training. Nursing home staff members need to be properly trained on how to prevent falls in at-risk residents. If a staff member does not understand resident risk (e.g. their medication schedule) or how to properly transfer a patient (from the bed to a wheelchair, from a wheelchair to the bathtub, etc.), a fall can occur.
  • Hazards. Nursing homes are responsible for ensuring there are no hazards that lead to an increased fall risk for residents already vulnerable due to medication and age. Potential hazards include wet floors, malfunctioning equipment (e.g. bedrails or walkers), and poor lighting.

Fall cases against nursing homes

If your loved one has suffered a fall at a nursing home, you will want to know how the fall happened. Nursing homes should always document and report all resident falls. Ask for a detailed explanation. The nursing home should also conduct a detailed review of your loved one’s medications to reassess medical necessity and determine how to prevent future falls.

Falls can result in chronic pain and reduced mobility, seriously impacting your loved one’s quality of life. You can talk to a lawyer to determine if you have a case and can pursue damages.

If you do move forward with a case, the nursing home may be responsible for paying a settlement. A settlement could cover the medical expenses, such as surgery or physical therapy, which occurred as a result of the fall. If your loved one dies due to a fall, you may have the option of pursuing a wrongful death case against the nursing home. 

Medication & falls FAQs

Nursing home falls are supposed to be preventable. If your loved one falls, you will have questions.   

How do I know if my loved one has suffered a fall at a nursing home?

When nursing home residents take medications that increase their risk of falling, family members need to be aware of that risk. If your loved one falls, the nursing home should report the incident to you and the facility’s administration. The facility may be required to report the fall to outside agencies.

If the nursing home did not report the fall, it may be up to the family to recognize the signs of a fall.

  • Do you notice unexplained bruising?
  • Is your family member struggling more than usual with mobility?
  • Do you notice any new signs of pain?

What do I do if the nursing home doesn’t tell me about my loved one’s fall?

Nursing homes are required to report patient falls, but this is not always the case. Frequent falls can affect a facility’s Medicare reimbursement, and frequent falls can trigger investigation by outside agencies.

If you find out about a fall that the facility did not tell you about, you should file a complaint with the nursing home’s administration. You can also report the incident to the Arizona Department of Health Services. If you need help, you can reach out to the Long-Term Care Ombudsman Program.

You should also request to sit down with your loved one’s care team to review their medication plan. Determine if all medications are necessary or if there are any medications that can be reduced or stopped entirely to help reduce the risk of another fall.

When should I consider talking to a lawyer?

You always have the option to talk to a lawyer after you discover your loved one has suffered a fall due to medication. Some common reasons to talk to a lawyer include:

  • Injuries: Falls caused by medication can result in bone fractures that require surgery and physical therapy to fix. A settlement could help cover the cost of medical bills related to the fall.
  • Death: Falls in the elderly can be fatal. If a nursing home’s negligence allowed a fatal fall to happen, the surviving family members can pursue a wrongful death case against the facility.
  • Fear of future negligence: A fall can indicate serious flaws in a nursing home’s policies and quality of care. If you are concerned these flaws could allow another fall to happen to your loved one or another patient, a lawsuit could play a role in changing policy at the facility.

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