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The Devastation of Falls among Older Patients
Richard M. Pescatore. Emergency Medicine News, 2024-06-01
Topic: Risk, prevention and care in population studies
Falls are an important event in a senior citizen's life, and offer the potential for significant morbidity and mortality. Indeed, the introduction of the Geriatric Emergency Department Guidelines in 2013 has marked a significant commitment to enhancing the care provided to this population within the ED setting. Skeletal muscle relaxants Potential for sedation and dependency; limited efficacy in long-term use Barbiturates High risk of dependence, overdose, and significant CNS depression First-generation antipsychotics Increased risk of extrapyramidal symptoms and anticholinergic side effects First-generation antihistamines Sedation, dizziness, and increased fall risk due to anticholinergic burden Hypnotic “Z” drugs Risks of cognitive impairment, daytime sedation, and complex sleep-related behaviors Metoclopramide Risk of tardive dyskinesia, especially in older patients with long-term use Sulfonylureas Increased risk of severe hypoglycemia, especially in older patients Strikingly, mild hyponatremia, though often overlooked or discounted, has been well-documented for its association with increased fall risk, leading to unsteadiness and attention deficits. The Beers Criteria This focus on underlying and holistic factors naturally leads us to consider the significant role that medications play in the safety of our older patients. Common prescriptions, such as sedatives and antihypertensives, have long been associated with poor health outcomes. Use of the medications listed on the Beers List has been found to be associated with adverse outcomes including confusion, falls, and death. These guidelines offer a renewed focus on medication management, specifically designed to reduce fall risks and improve overall outcomes for older patients. The medication classes identified include common culprits such as benzodiazepines, skeletal muscle relaxants, and barbiturates, each associated with sedative properties that can impair cognition and physical stability. Also highlighted are first-generation antipsychotics and antihistamines, which due to their pronounced sedative and anticholinergic effects pose significant risks of falls and cognitive decline. These drugs, known for their roles in sleep management, gastrointestinal mobility, and glucose regulation, respectively, have been scrutinized for their side effects that may subtly yet significantly impair older patients' health.
Key findings
- Falls are an important event in a senior citizen's life, and offer the potential for significant morbidity and mortality.
- Indeed, the introduction of the Geriatric Emergency Department Guidelines in 2013 has marked a significant commitment to enhancing the care provided to this population within the ED setting.
- Skeletal muscle relaxants Potential for sedation and dependency; limited efficacy in long-term use Barbiturates High risk of dependence, overdose, and significant CNS depression First-generation antipsychotics Increased risk of extrapyramidal symptoms and anticholinergic side effects First-generation antihistamines Sedation, dizziness, and increased fall risk due to anticholinergic burden Hypnotic “Z” drugs Risks of cognitive impairment, daytime sedation, and complex sleep-related behaviors Metoclopramide Risk of tardive dyskinesia, especially in older patients with long-term use Sulfonylureas Increased risk of severe hypoglycemia, especially in older patients Strikingly, mild hyponatremia, though often overlooked or discounted, has been well-documented for its association with increased fall risk, leading to unsteadiness and attention deficits.
- The Beers Criteria This focus on underlying and holistic factors naturally leads us to consider the significant role that medications play in the safety of our older patients.
- Common prescriptions, such as sedatives and antihypertensives, have long been associated with poor health outcomes.
Why it matters
This article describes how falls cause significant illness and death in older patients and lists medications, such as sedatives and certain antipsychotics, that increase fall risk. It notes that mild hyponatremia is associated with increased fall risk and that the Beers Criteria help identify medications that may be unsafe for older patients.
Study details
- Evidence strengthLow
How this study scored 25/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on senior author's track record and institution's track record, so those were left out: it earned 23 of the 93 points we could judge it on, which is 25 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Emergency Medicine News) |
| Journal's citation record | 0 / 4 | Emergency Medicine News: journal h-index 14 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | OpenAlex's profile for last-listed author Richard M. Pescatore holds only 3 work(s), too few to judge a track record — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 0 institution(s) in 0 countries — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 23 / 93 | Scored on 18 of 20 parts. We have no data for the rest, so they are left out: 23 of the 93 points we could judge it on is 25 out of 100. |
| Total | 25 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Pescatore, R. M. (2024). The Devastation of Falls among Older Patients. Emergency Medicine News. https://doi.org/10.1097/01.eem.0001024224.26476.2b
Vancouver
Pescatore RM. The Devastation of Falls among Older Patients. Emergency Medicine News. 2024. doi:10.1097/01.eem.0001024224.26476.2b.
BibTeX
@article{pescatore2024-7d44db82,
author = {Pescatore, Richard M.},
title = {{The Devastation of Falls among Older Patients}},
journal = {Emergency Medicine News},
year = {2024},
doi = {10.1097/01.eem.0001024224.26476.2b},
url = {https://doi.org/10.1097/01.eem.0001024224.26476.2b}
}
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