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Pain Medications, Falls and Our Elderly: What Payers, Providers Can Do Now

, May 23, 2014

What happens when the treatment for one medical condition inadvertently contributes to a health crisis? Too often, the treatment for lower back pain among the elderly begins and ends with prescription painkillers. But those medications can lead to disorientation and balance issues, which can result in falls that contribute to fractures, incapacitation, retreat into nursing care, and even death. 

Lower back pain is the most reported musculoskeletal issue for seniors, whether it is from degenerative disc problems, lumbar strain and radiculopathy, bone and joint conditions, or bony encroachment such as arthritis. Research suggests that 80 percent of patients with lower back pain are prescribed at least one medication, and more than 30 percent are prescribed two or more medications. 

“One common cause of falls — medication — is often overlooked, even by health care professionals,” concluded Social Work Today recently. “Medications and their side effects contribute significantly to the risk of falling in older adults.”

The magazine addresses the rising incidence of polypharmacy — a “cocktail” of prescription medications with side effects that can include reduction in balance — and cites the American Society of Consultant Pharmacists Foundation, which concluded that a quarter of the elderly now take five or more prescription drugs regularly.¹

Although there are many potential treatments for lower back pain, it’s prescription medication that can cloud a senior’s mind and make them more prone to falls. And balance issues leading to falls are, in turn, the number one cause of institutionalization of seniors.² In fact, studies estimate that up to 35 percent of the elderly fall each year.³ The impact of those falls on the elderly, their families, and on health insurers can’t be overstated: American Family Physician reports that 1,800 falls annually result in death, with more than 90 percent of all hip fractures happening because of falls.4 More than one-third of hospital injury admissions are seniors — and over 80 percent of those admissions were the result of falls.5

“Drug treatment is generally the first and most widely used treatment modality to control geriatric pain,” concludes Pain Management In the Elderly Population, warning that, “prescribing these medications is not without risks, however. The patient’s cognitive, physiological and functional status may be affected.”6 

Everyone along the health care continuum, from health insurers, to primary-care physicians, to providers, to health care advocates and elder-care organizations,  must do a better job of keeping our elderly functional and healthy. That means reconsidering the current focus on pain medication and, instead, being open to a multi-level, interdisciplinary treatment program for lower back pain, including lumbar stabilization exercise; chiropractic and physical therapy; improvement of the patient’s environment (i.e., no loose rugs, wet floors, etc.); movement training; meditation; acupuncture; heat and massage therapy. 

I am hopeful that 2014-2015 will be the year that physicians and chiropractors join forces to challenge the most commonly accepted treatment for lower back pain — and, by reducing the over-reliance on prescription drugs for seniors experiencing lower back pain, begin to reduce the epidemic of falls that is entirely avoidable. What are your thoughts on this urgent public health issue?

 


 

1 Van Pelt, Jennifer, “Medication-Related Fall Prevention,” Social Work Today, Vol. 12, No. 1, p. 12, January – February 2012 issue.

2 Balance Problems in the Geriatric Patient, Enix, Flaherty, Sudkamp, Schulz, Topics in Integrative Health Care, March 30, 2011.

3 Blake AJ, Morgan K, Bendall MJ, Dalloso H, Ebrahim S, Arie T et al, Falls by elderly people at home: prevalence and associated favors, Age Ageing, 1988.

4 Fuller, George, Falls in the Elderly, American Family Physician, 2000 April 1.

5 Greenwald BD, Burnett DM, Miller MA. Congenital and acquired brain injury. Arch Phys Med Rehabil 2003.

6 Kaye, Alan, D; Baluch, Amir; Scott, Jared, Pain Management In the Elderly Population, The Ochsner Journal, Fall 2010.