NFPA Journal - Summer 2022 - 78

Falls & Fires
Medication Focus
NFPA's new Steps to Safety program
addresses the role of drugs and
alcohol in falls and fires
or years, health and safety experts
have believed that prescription medication
and drug use among seniors is a significant
factor in falls, and possibly fires.
But research on the issue has been scattered,
making it difficult to draw conclusions
or to formulate and deliver appropriate
safety messages. As a result, the
topic has been absent from efforts like Remembering
When, an NFPA educational
program aimed at helping seniors reduce
their risk of experiencing a fire or fall.
Recently, though, calls by the safety
community to re-examine the issue led
NFPA to ask its research affiliate, the Fire
Protection Research Foundation, to investigate.
Last year, the Foundation contracted
with FireTox, a Maryland-based research
firm, to review relevant academic
studies on the topic and catalog the insights.
The resulting report, " Review of
Impact of Medications on Older Adult Fall
and Fire Risk, " published last fall, leaves
little doubt as to the role that medications
can play in causing falls among seniors,
said Jamie McAllister, the technical
director at FireTox and the lead author of
the report.
" There are a number of medications
identified in the sources we reviewed that
were found to increase the risk of falls
and fall injuries for older adults, " McAllister
said. " In addition, removing or replacing
a certain medication, or maybe even
just reducing the dose of the medication
in somebody's treatment regimen, can actually
prevent the occurrence of a fall. "
One outcome of the findings is that
medication use is now a focus of Steps to
Safety, the new older-adult falls and fire
prevention program designed by NFPA.
Steps to Safety builds on the messaging
of Remembering When with a more flexible
digital delivery featuring video, social
media, and other engagement tools.
The program is scheduled to launch this
summer.
According to the FireTox report, older
adults taking antidepressants, benzodiazepines
(such as Xanax and Valium), opioids,
and insomnia medications seem to exhibit
an increased risk of cognitive impairments,
falls, and fractures. Taking these
drugs in combination can increase the
risk. Conversely, removing drugs may have
a beneficial effect. In one study, researchers
weaned fall-prone patients off psychotropic
drugs and found that it decreased
the occurrence of falls by 66 percent.
While the findings seem fairly intuitive-it's
no surprise that an older adult
78 | NFPA JOURNAL * SUMMER 2022
F
struggling with balance will struggle more
under the influence of a psychoactive
chemical-further digging reveals some
startling details, including the finding that
older adults are taking pharmaceuticals in
fantastic quantities and in combinations
that could be dangerous.
According to research reviewed in the
report, 66 percent of adults 65 and older
use three or more prescription medications,
and approximately 42 percent use at
least five or more. Perhaps because of this
intake, one study found that 25 percent of
seniors have had one or more drug-drug
interactions, meaning they've taken two or
more drugs that have unfavorable results
when taken together. Roughly 15 percent
of older adults-more than 8 million people
in US-are at risk for potential " major
'We should be
encouraging an open
dialogue around the
real-world challenges
that our most vulnerable
populations face,
because a lack of
authentic engagement
isn't working for us.'
drug-drug interactions, " according to one
study detailed in the Foundation report.
What's more, as much as 35 percent
of the older adult population drinks while
taking medications that are known to interact
negatively with alcohol. Taking certain
drugs in combination or with alcohol
can " create this additive or synergistic effect, "
McAllister said. Often it can enhance
or otherwise impact the absorption, distribution,
metabolism or even the physiological
effect of the drug, and possibly make
a patient who is already unsteady on their
feet even more so.
When it comes to medications and their
impact on fire risk, however, the available
research is thinner and less conclusive.
" We have a much smaller pool of studies
that have been conducted, and they've
largely focused on how medications impact
awakening to a smoke alarm, " McAllister
said. " But little research has been
done on how drugs affect us when we are
awake and if they might affect one's ability
to perceive a fire hazard and respond
accordingly. "
Although the findings were inconclusive
about how drugs impact fire risk,
there were several studies included in the
Foundation report that strongly suggest
a correlation, if not a direct causation.
Of particular concern are drugs that induce
a deep sleep, such as benzodiazepines,
sleeping aids, and alcohol. One
study, from 1997, looked at a series of tests
on people who had been given drugs and
then assessed on how easily they were
awakened by a smoke alarm. In one of
those tests, from the 1970s, half of the
participants who were given benzodiazepines
failed to wake to the first alarm signal.
The researchers concluded in the 1997
study that higher amounts of alcohol or
drugs " will cause longer stages of deep
sleep that may leave the person in a comatose
state. "
More broadly, studies have revealed
that drugs and alcohol show up with some
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