Stopping meds to reduce falls in people with dementia

Researchers at the University of Washington medical and pharmacy schools and at the Kaiser Permanente Washington Health Research Institute will test a program to reduce use of drugs that increase the risk of falling among older adults with dementia.

The project will focus on making patients with dementia, their care partners and physicians more aware of how certain drugs that affect the central nervous system, such as sleeping pills, anti-anxiety medications and pain relievers, increase the risk of falls. A goal would be to provide strategies to reduce the use of these medications.

“Most older adults and many clinicians are not aware that medications are a key contributors to falls,” said the effort’s leader, Dr. Elizabeth Phelan. She is a professor of gerontology and geriatric medicine at the UW School of Medicine and director of the Fall Prevention Clinic at UW Medicine’s Harborview Medical Center. “The goal of this project is to find out what approaches are effective to reduce the burden of those medications that contribute to falls in this population.”

Falls are a major cause of serious injury and death among older adults in the United States. According to the U.S. Centers for Disease Control and Prevention, 1 in 4 older Americans report a fall each year and about 74 die from fall-related injuries each day. People with dementia are at even higher risk because gait and balance difficulties often accompany dementia; spatial awareness and judgement may be impaired as well.

Although drugs that act on the central nervous system can impair an individual’s ability to walk and stand safely, they are commonly prescribed to older adults with dementia. A 2021 study published in the journal JAMA found 1 in 5 patients with dementia was taking three or more medications that act on the central nervous system.

“In these patients, the risk/benefit balance of treatment with these drugs is tipped towards greater risk,” Phelan said. “They’re really medications we want people with dementia to stay away from.”

The project will seek to adapt interventions developed by Phelan and her colleagues for older adults in general, called STOP-FALLS, to be more suitable for patients with dementia. The new program is called STOP-FALLS-D.

The project will look at low-tech solutions, Phelan said. “It’s a very simple, “nudge” intervention: sending educational material to patients and decision support to health-care providers to help them address the use of these medications with their patients.”

The researchers will assess the effectiveness of their intervention by tracking the number of falls that require medical attention and the prescribing practices of physicians caring for these patients.

STOP-FALLS-D is funded by the National Institute on Aging (3U54AG063546).

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