Judd Matsunaga
American comedian Henny Youngman was famous for his mastery of the “one-liner,” the most famous being, “Take my wife . . . please.” I really liked his doctor jokes (reminded me of my dad). For example, “The patient says, ‘Doctor, it hurts when I do this.’ Then don’t do that!” Or, “Doctor, my leg hurts. What can I do? The doctor says, ‘Limp!’” Or, the doctor says, “You’ll live to be 70. ‘I AM 70!’ See, what did I tell you?” Finally, “The doctor says to the patient, ‘Take your clothes off and stick your tongue out the window.’ ‘What will that do?’ asks the patient. The doctor says, ‘I’m mad at my neighbor!’”
Of course, there’s the ancient Chinese joke — A man visits his terminally ill friend and finds him to be well. “How wonderful!” he says, “You look so energetic, what happened?” The man replies, “Dr. Chang is the cause of my health,” he says with a smile. “Dr. Chang??? What did he do?” asks the friend. The man explains, “Well, Dr. Li gave me a special tea, and I got sicker. So then, Dr. Wong came and gave me bitter herbs, and I got even worse. But on death’s door, I called for Dr. Chang.” “And what did Dr. Chang do?” his friend asks in wonder. The man replies, “Dr. Chang didn’t show up, and I got well!”
Back in the medieval times (500-1500 AD), doctors would try to cure various ailments by “bloodletting,” i.e., cutting a vein to drain blood, often weakening the patient to the point of death, making the “cure” far deadlier than the illness.
Perhaps the most famous bloodletting case was that of George Washington. It was thought that he had a throat infection, and the physician drained over eight pints of blood to treat the infection. This was too much for his body to handle, and he died shortly after.
In today’s modern medicine, chemotherapy is the usual course to treat cancer. Standard chemotherapy does not differentiate between healthy cells and cancerous ones. Therefore, standard chemotherapy causes significant side effects that are often worse than the cancer itself. Chemotherapy side effects result from damage to healthy cells, causing common issues like fatigue, nausea, hair loss, mouth sores and increased infection risk due to lowered blood counts.
In like manner, many seniors are taking medications where the “treatment is worse than the disease.” This Pacific Citizen article discusses how some medications that doctors commonly prescribe to older adults will increase fall risk.
In other words, a broken hip is worse than anxiety or loss of sleep. If you are worried about falls in an aging parent or relative, you need to know that fall risks can be reduced by reviewing their medications.
Some drugs affect brain function and may tend to cause some sedation or drowsiness. They can also cause or worsen confusion, especially in people with memory problems or Alzheimer’s disease.
Following is a list of 10 common types of medications associated with falls. If you’ve been concerned about falls and want to request a medication review, this list will help you identify medications to discuss with your doctor (source: www.betterhealthwhileaging.net).
1. Benzodiazepines: Often prescribed to help people sleep or help with anxiety. They do work for this purpose, but they are habit-forming and have been associated with developing dementia. Clinical research studies consistently find that benzodiazepines are associated with increased fall risk. Commonly prescribed brand names are Ativan, Valium, Restoril and Xanax.
2. Nonbenzodiazepine prescription sedatives: These drugs are usually prescribed to treat insomnia or sleep difficulties. These have been shown in clinical studies to impair balance — and thinking! — in the short-term. This group includes the brand names Ambien, Sonata and Lunesta.
3. Antipsychotics: Originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms, they are commonly prescribed to control difficult behaviors in Alzheimer’s and other dementias. They are also sometimes prescribed to people with depression. Clinical research indicates that antipsychotics are associated with increased falls. Commonly prescribed brand names are Risperdal, Seroquel, Zyprexa, Haldol and Abilify.
4. Anticonvulsants/mood-stabilizers: Originally developed to treat seizures, they are also used to stabilize mood in conditions such as bipolar disorder and to treat difficult dementia behaviors. They can also be used to treat certain types of nerve pain. Clinical research suggests that anticonvulsants are associated with increased fall risk. They also tend to have many other problematic side-effects in older adults. Commonly prescribed brand names are Depakote and Neurontin.
5. Antidepressants: These are medications prescribed to treat depression. Some of them are also used to treat anxiety. Virtually all antidepressants have been associated with an increase in fall risk. Commonly prescribed brand names are Zoloft, Celexa, Lexapro, Paxil, Remeron, Wellbutrin, Effexor and Prozac. Trazodone is an older antidepressant that is now used almost exclusively as a mild sleep aid.
6. Opioid (narcotic) analgesics: Opioids are mainly used for the treatment of pain. Opioids often cause drowsiness, as well as other side-effects. A 2020 meta-analysis of opioids did find an association with falls, fall injuries and fractures. Most experts — including the CDC — recommend that narcotics use be evaluated as part of fall risk management. Commonly prescribed brand names include codeine, hydrocodone, oxycodone, morphine, fentanyl and methadone.
7. Anticholinergics: This group covers most over-the-counter sleeping aids, as well as a variety of other prescription drugs. These are medications that have the chemical property of blocking the neurotransmitter acetylcholine. Anticholinergics commonly cause sedation. They can also cloud thinking and have been associated with developing dementia. Given that anticholinergics can cause drowsiness and are risky for older adults for other reasons, many experts believe it’s reasonable to include them when reviewing medications for fall prevention. Commonly prescribed brand names include Benadryl, Nyquil, Tylenol PM, Antivert, Scopace and Phenergan.
8. Antihypertensives: These are commonly used to treat high blood pressure. Clinical research on blood pressure medications and fall risk has shown mixed results. Despite the mixed clinical evidence, many geriatricians and other experts do recommend re-evaluating BP medications in older adults at high risk for falls.
9. Other medications that affect blood pressure: There are some commonly used medications that are not usually prescribed for hypertension but still lower BP or increase postural BP changes in many older people. A 2015 study found that the use of prostate-specific alpha blockers was associated with a higher risk of fall and fracture in older men. Commonly prescribed brand names are Flomax, Hytrin, Cardura and Minipress.
10. Medications that lower blood sugar: Many older adults with diabetes take medications to keep their blood sugar from getting too high. Most diabetes medications can cause or worsen hypoglycemia (too low blood sugar).
In conclusion, if you or your loved one have fallen (or almost fell) recently, go see your doctor for a medication review. If you see any of your medications on the above list, please note that it can be dangerous to stop taking them suddenly. Medications that increase fall risk should always be tapered, under medical supervision.
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
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