In older people, the combination of three or more drugs acting on the central nervous system — antidepressants, antipsychotics, benzodiazepines, Z-drugs, opioids, antiepileptics — is listed in the American Geriatrics Society Beers Criteria as a combination to avoid because of the increased risk of falls and fracture.
During a medication review, listing these drugs together, with the reason and start date for each, often shows that one was started for a problem that has passed. Stopping or reducing one at a time, with a planned review, is established deprescribing practice.
- List all central nervous system-active drugs separately at each medication review.
- Flag any combination of three or more as a falls risk.
- Record the original reason and start date for each.
- Taper one drug at a time, with a planned review date.
Why it matters
Total pill count hides the specific combination that most often causes falls.
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