Why do more elderly people die after suffering?

For a while, the dog walking became dangerous.

Earl Vicars used to get Molly, a mixture of dog from the German shepherd, boxer, and something else, walking on the beach or neighborhood in the seashore, California.

However, a few years ago he started facing problems.

“Every time another dog came to us, the matter ended on the ground,” said Vicers, 69, a retired electronic engineer. “It seems that I fell every two months. It was crazy.”

Most of these falls did not cause severe damage, although he once fell on his back and hit his head on the wall.

“I don’t think I was shocked, but this is not something you want every day,” Vicars said with a paradox. On another occasion, when trying to stop falling, bones were broken from the left hand.

So in 2022, the oncology doctor told him that he treated him due to prostate cancer that he wanted to stop taking the medicine he was using intermittently, for four years: Enzalutamide (sold under the brand name of XTandi).

Of Side effects Which is attributed to this drug are higher rates of fall and fractures in the patients they use, compared to those who receive an imaginary drug. His doctor agreed to suspend the treatment, and according to Vicers, “I have not fallen again since then.”

Public health experts have warned for decades of the dangers of the elderly.

In 2023, in the last year with the data available to the Centers for Disease Control and Prevention (CDC), more than 41,000 people died over 65 years of fall, according to Opinion Posted in August in Jama Health Forum.

But it is more surprising that this number was another fact: the deaths of the falling of the elderly increased in a clear way.

The author of the article, Thomas Farley, the epidemic scientist, stated that death rates due to the fall injuries in people over the age of 65 have multiplied three times in the past thirty years. In a group greater than 85 – the highest risk – the death rate caused by the decrease from 92 per 100,000 people in 1990 decreased to 339 per 100,000 in 2023.

According to his opinion, the perpetrator is the adoption of prescribed medications.

“The elderly are very treating, more and more, and with drugs that are not suitable for their age,” Farley said in an interview. “This didn’t happen In Japan Not in Europe. “

And that during that same period of 30 years, there was an ice breakdown of research and procedures to reduce the fall of the elderly and their potential destructive consequences, such as hip fractures, cerebral bleeding, loss of movement, persistent pain, and even institutionalization.

The American Society for Aging Medicine has updated it Fall prevention evidence In 2011. The Disease Control Center launched a program called Steadi In 2012. The Preventive Services Group in the United States recommended in 2012, 2018 and again last year Sports may exercise at risk or receive physical therapy.

“Studies, interventions and investments, and they were not particularly successful.” “It is a serious problem that seems to be increasing.”

But are the prescribed medications that cause this increase? Aging doctors and other experts studying the fall and medical prescription practices doubted that the conclusion.

Farley, the former New York City Health Commissioner and the current professor at the University of Toleen, admitted that many factors contribute to the decrease: physical deterioration, loss of vision with alcohol consumption and risks inside the home.

But I add that “there is no reason to believe that any of these factors has worsened three times in the past thirty years,” and indicates studies that appear a Decrease in other high countries.

He said that the difference is the increasing use of drugs in the United States – such as benzodiazepines, opioids, antidepressants, and jababinin – that affect the central nervous system.

“Medicines that increase deaths due to the fall are those that make you feel sleepy or dizzy,” he explained.

There are a lot of problematic drugs that have an acronym: FRIDS, in its name in English “Medicines that are at risk” (medications that increase the risk of falling). This category also includes some heart medications and first antihistamines, such as benadryl.

These treatments play an important role, and Thomas Jelly, Girarta and epidemic specialist at Yale University, with years of experience in investigating the fall. But he also said that “there are other interpretations” possible to increase death rates.

He mentioned, for example, the changes in how to report the causes of death. “For years, the fall was considered a natural result of aging, without great importance,” he said.

Death certificates are often attributed to diseases such as heart failure, not to fall, causing a death rate in the 1980s and 1990s.

Gil added that people over the age of 85 today may be more fragile and be more ill from those that preceded 30 years, because current medicine allows life to be prolonged.
Their multiple diseases can make death more likely to die, more than the medications they take.

Another argued, Neil Alexander, an old age doctor and an expert in the fall of the University of Michigan and the veteran health system in Ann Arbor, that most doctors already understand the risks of FRIDS and the lowest prescription.

“The message has arrived,” he said. Given the warning level that was more than opioid materials, benzodiazepines, especially the joint use of both, “many primary care doctors have already heard the sermon,” he said. “They know that they should not describe today for the elderly.”

In addition, the recipes of some of these medications decreased or settled, while the deaths caused by the fall continued to increase. For example, Medicare data shows that the use of the prescribed opiates It started to decrease A decade ago. The benzodiazepines recipe in older patients has also slowed, according to Maus.

However, on the other hand, Using antidepressants Y Gabapentin.

Regardless of whether or not the main factor is the main factor, “no one discusses that these drugs are used excess and inappropriately,” Jill said, and that they contribute to the anxious increase in deaths due to the decrease in the elderly.

Hence the current campaign in favor of “discomfort”: suspending medicines whose potential damage exceeds the benefits, or at least reduce its dose.

“We know that many of these drugs can increase by 50 to 75 %,” said Michael Steinman, Grace at the University of California, San Francisco and the director of participation in the elderly. The United States that prevents the research networkCreated in 2019.

“It is easy to start medications, but often you need a lot of time and effort for patients to leave them,” explained. Doctors, workers, can lend less attention to the drug system than more urgent health problems, and patients tend to leave medications that help them pain, insomnia, reflux and other common problems.

Los Bires standardsThe medicine guide is considered a few desirable for the elderly, recently published Recommendations On alternative medications and non -drug treatments for common problems: cognitive behavioral therapy; Exercise, physical therapy and psychological interventions of pain.

“It is a real tragedy when people live in an event that changes their lives in this way,” said Steinman, who heads the committee committee. Bires standards On alternative treatments.

He recommended that the elderly speak with their doctors about Frids if they did not mention it.

Ask: “Which of my drugs increases the risk of falling? Is there any alternative treatment? “To be aware, whether as a patient or as a career, this topic can help. Otherwise, it may not be mentioned. “

New old age It is a production in cooperation with New York Times.