Have you had any concerns about an older person falling, or being at risk for a broken hip?
The study, completed by a team of geriatrics researchers at Yale, found that in older adults aged 70 or older, taking blood pressure medication was linked to a higher risk of serious falls. (Serious falls as in, falls that caused an ER visit for a fracture, a dislocated joint, or a brain bleed. Serious stuff indeed!)
So, if the person you care for has a diagnosis of hypertension, and if you’ve had any concerns regarding falls or near-falls, these study results should be of interest to you.
In this post, I’ll review the key results of this study. Then I’ll tell you what I think are the most important practical take-aways for family caregivers.
This post will also include some practical tips to help you minimize the risk of your loved one experiencing a serious fall.
Key results of the high blood pressure medications and falls study
One of the many good things about the study is that it used the Medicare records of a “real-world” group of 4961 people aged 70 or older. (This is important because many clinical trials of BP medication are done with patients recruited specifically for the study; there are advantages to this but it means that often patients in clinical trials are healthier than the aging adults that you and I are caring for.)
To be included in this “real-world” study, the patients had to have a diagosis of high blood pressure, they had to be living at home or in assisted-living, and they had to be in Medicare fee-for-service (no Medicare Advantage patients).
The researchers then examined three years worth of these patients’ Medicare records. Here’s what they found:
- Overall, 9% of these older people experienced a serious fall injury.
- When people were classified based on how much BP medication they were taking, the percentages of aging adults having a serious fall within 3 years were:
- No medication: 7.5%
- Moderate-intensity BP medication: 9.8%
- High-intensity BP medication: 8.2%
Next the researchers used some statistical adjustments, to compare older adults with similar levels of illness burden. (It’s important to do this adjustment, because otherwise it could be that some people have no BP medication because they are so sick and frail that doctors have stopped their medications.) In this adjusted group, the percentages of older adults having a serious fall over 3 years were:
- No medication: 7.1%
- Moderate-intensity BP medication: 8.6%
- High-intensity BP medication: 8.5%
The researchers also found that in those people who’d had a serious fall injury within the previous year, being on BP medication was linked to an especially high chance of another serious fall.
What you should take away from this study
I consider this study very important, because most clinical research focuses on benefits of medication, rather than studying the potential harms and downsides of medication. It’s probably not a coincidence that the main author is a geriatrician; we tend to feel that a little goes a long way when it comes to medications in aging adults!
Key take-aways for family caregivers:
- Serious falls are a fair possibility in all older adults aged 70+. Over 3 years, 9% of these Medicare patients had a fall involving a fracture, a dislocation, or a brain bleed. It’s probably reasonable for you to assume that your loved one has at least a roughly 10% chance of a serious fall within a few years. This risk is higher if your loved one has already had a serious fall.
- Consider learning practical approaches to reducing fall risk in your loved one. Along with learning to be careful with medications, there is lots more that you can do! Visit our fall prevention topic page to see all our articles on this topic.
- Consider a plan or system to call for help in the event of a fall. This is especially important for those independent older adults who live alone! Last year I saw a patient who lay at home with a broken hip for 2 days before he was found 🙁
- Home sensors and/or a personal emergency response system can help alert a care circle when an older person falls.
- Being on blood pressure (BP) medication raises the risk of a serious fall. This doesn’t mean your loved one shouldn’t take any medication for high BP. But it does mean that you should be thoughtful about weighing the benefits and the risks, and you probably want to aim for the lowest doses possible. In my experience, regular doctors tend to not think of the risks of BP medications in aging adults. So here are some specific things YOU can do:
- Be careful if your loved one’s BP is often below the new recommended target of 150/90. Read “What the New Blood Pressure Guidelines Mean for Older Adults” for more info.
- Ask the doctors to help you understand how much benefit to expect from the BP treatment. Note that often the expected chance of benefit (e.g. avoiding a stroke or heart attack) is about the same as the risk of harm that was found in this research study.
- Seniors who’ve had a previous serious fall are at extra high risk. Be extra careful about blood pressure and over-treatment if your loved one has already had a serious fall. These are the older adults for whom it’s most important to make sure that they aren’t on more medication than is absolutely necessary.
- Know that in general, the most benefit from treating high blood pressure in seniors comes from getting a systolic blood pressure (SBP; that’s the top number that a monitor reports) from 170 or higher, down to 140s-150s.
- Once elderly people are treated to a SBP below 140, the chance of harm can easily become bigger than the chance of benefit.
- Get a home blood pressure machine if you’re concerned about falls and your loved one is on medication. Don’t just leave it to the doctors to monitor things and take action. When properly done, home BP measurements can be more accurate than occasional office measurements, and can lead to better care. For more on this topic, here are some posts I wrote last fall:
Do you have any questions about how to reduce the chance of falls and injuries in aging adults?
Please post them below in the comments section.