Although they say pride goes before a fall, usually it’s feeling faint or dizzy that’s the precursor. Studies show an increased risk of falling is associated with certain medications. Further, the more medicines you’re on, the greater the likelihood that there is a fall in your future.
Prescription and over-the-counter (OTC) drugs can both cause falls. Prescription medications that depress the central nervous system, such as tranquilizers, muscle relaxers, pain relievers with codeine and insomnia agents, slow your reaction time and make you less alert. They can also cause dizziness and sleepiness, and can impair your coordination. Even common OTC cough and cold remedies and allergy medicines can lead to daytime drowsiness, increasing your risk of falling.
People with bleeding disorders who are on multiple medications to treat co-morbidities, or concurrent health conditions, need to be aware of the potential for taking a tumble. “The more medicines people have on board as they get older, the higher the risk that they’re going to have problems with dizziness and drug interactions that can put them at risk for falls,” says Angela Lambing, MSN, NP-C, of the Hemophilia and Thrombosis Treatment Center at the Henry Ford Health System in Detroit. The US Centers for Disease Control and Prevention (CDC) estimates that one-third of people age 65 and older fall every year. Falls not only lead to fractures, but are also the leading cause of fatal injuries in that age group, according to the CDC.
“With the hemophilia population, falling is a very real issue because as people age, we’re seeing more co-morbidities like diabetes and hypertension,” says Lambing. Diabetic neuropathy, or nerve damage, can affect the lower legs and feet, causing a loss of sensation. For people with arthritic knees or ankles from years of joint bleeds, walking can become compromised. “If they’re not able to move well and then they can’t feel well with their feet when they’re walking, they may not lift them appropriately,” she says. “They’re at risk for falling.”
In addition, the very medications you’re taking to lower high blood pressure can also contribute to falling. Antihypertensives can cause hypotension—low blood pressure—when a patient tries to get out of bed or moves from a sitting to a standing position. “The blood rushes from the head to the feet, and you can pass out,” says Lambing. “We teach a lot of patients to get up slowly.” Sitting on the edge of the bed for a few minutes before you stand up in the morning can help.
HTC and Home Safety
Your hemophilia treatment center (HTC) is a good place to start if you’re concerned about falling inside your home. Typically, a physical therapist performs a home safety assessment to identify problem areas and offer solutions. “We make sure there are no throw rugs they could trip over or carpets curling up at the edges,” Lambing says. The bathroom is also evaluated. Hand rails, a raised toilet seat and a tub chair are often recommended.
The house itself may be the biggest obstacle, though, says Lambing. Older men with hemophilia have less mobility in their ankles, knees and hips. “So climbing stairs becomes a problem,” she says. “Sometimes we will have a conversation about whether it’s time for them to change to a one-level home.”
In some cases, improvements may be needed on the homeowner, not the home. Mobility issues can often be managed through physical therapy, whether it’s in the home, in a pool or outpatient facility, says Lambing. “We try to make sure that we’re optimizing their physical functioning. We’re trying to maximize what they have to minimize that fall risk.”