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09/15/2025 Paul Kesselman, DPM
Increased Risk of Fatal Falls
A recent article in September 7, 2025 NY TImes
entitled Why Are More Older People Dying After
Falls, is a must read for every physician, no
matter their specialty. The NY Times article
points out a threefold increase in fatal falls
over the last thirty years. This compared to a
decreased or steady number of fatal falls per
capita in other countries.
The reason cited by both the NY Times and its
source is the increased reliance on Fall Risk
Increased Drugs(FRID) in the U.S. JAMA News while
a much lengthier read, provides a substantial
amount of statistical analysis and is the
foundation of the findings cited in the NY Times
article..
Having no other motive but to decrease falls in
our most fragile patients, it is imperative to
look into whether our elderly patients are at a
higher risk of falling due to taking FRID,
whether those medications are prescription or non-
prescription. Gabapentin,one FRID identified
prescription medication, often prescribed by
podiatrists and other physicians is often the go
to drug for chronic pain.
With the various initiatives to reduce opioid
dependency, Gabapentin (and similar medications)
are often used for patients with pain particularly
of a neurogenic etiology (e.g. diabetic
neuropathy, radiculopathy, etc.). They have all
been identified as FRID.
Many of our patients also take other FRID
including proton pump inhibitors, diazepines and
beta blockers. While those latter gabapentin
certainly is. Other medications used to treat
urinary frequency, OTC antihistamines for both as
a sleep aid and for allergy relief, with the
latter sometimes prescribed by podiatric
physicians are also on the list of FRID.
It is no wonder the US has seen an increase in
fatal falls over the past decade.
Adding to this fatality risk is the increased
reliance on various anticoagulants (direct and non
direct agents) for a variety of cardiovascular and
neurological issues, one has a recipe
for a fall in our elderly patients being the last
thing that happens to them.
Having known several relatives and relatives of
friends who lost loved ones due to a fatal fall
and perhaps due to FRID with anticoagulants, it is
imperative that any fall prevention discussion
brings up the FRID +anticoagulant issue. Speaking
with the doctors who have prescribed these
medications is mandatory.
I had my then 90+ year old dad's cardiologist
discontinue him from coumadin, because he had not
had an arrythmia for 7 years prior. He was simply
on it due to a previous one-time event. Was this a
rational reason or not? A discussion with the
cardiologist and my dad came to the conclusion
that while a risk, it was a risk worth taking.
He fell many times after that yet he never
sustained a life ending fall!. Who knows what
would have happened from the many times he struck
his head in subsequent falls?
Yes, addressing proper footwear, identifying other
issues requiring referral (e.g. ophthalmology and
visual impairment, neurology and neuromuscular
issues) and removing hazards from the home are
also important in particular for patients who are
at increased risk of falling and particularly for
those where a fall may be deadly. Patients living
alone are also at higher risk for falls and fatal
falls as well.
Enlisting social services, referral to physical
and occupational therapy and enlisting other
modalities are also prudent discussion points to
have with your patients and their caregivers.
There certainly may be times when an AFO and other
ambulatory assistive devices (cane, walker, etc)
may also be appropriate, but that should occur
only after a thorough fall risk assessment is
conducted and all the issues involved identified.
Prescriptions and orders for AFO and walker will
no doubt fail if the primary reason for the
patient's fall risks are not properly addressed.
Paul Kesselman, DPM, Oceanside, NY
Other messages in this thread:
09/16/2025 Bob Smith, DPM, MSc, RPh
RE: Increased Risk of Fatal Falls (Paul Kesselman, DPM)
I would like to thank and applaud Dr. Kesselman
for his communication centered on the increased
risk of fatal falls. I also encourage all medical
professionals to not only explore these recent
suggested literature sources. Twenty-five years
ago, I started researching and developed a
narrative that was published as: Smith RG. Fall-
contributing adverse effects of the most
frequently prescribed drugs. J Am Podiatr Med
Assoc. 2003 Jan-Feb;93(1):42-50. The foremost
reason, purpose of this narrative was to document
the possible plausibility and causality of
medication inducing adverse effects. Given the
advances in technology and leaders in our
profession indicate that podiatrists should be the
leading professionals to identify and prevent
falls among our most vulnerable populations.
In July of 2025, I began a systematic literature
review to obtain actual statistics and numbers of
medications that induce fall injury. I have
obtained a wealth of information described as The
FDA adverse event reporting system database, drug
monographs describing the pharmacokinetics
properties, The AGS Beers Criteria 2023, and
auditory and vestibular side-effects of FDA-
Approved Drugs for Diabetes, and medication that
affect balance. A further goal for obtaining this
objective data is to develop an electronic
predicative tool. Moreover, with any tool that
prevails, the properties of clinimetrics is my
hope.
Perhaps podiatrists can integrate assessments for
fall risk in their prehabilitation; that provides
patients with exercise programs to optimize
strength and range of motion while also increasing
patient knowledge of and exposure to interventions
that they will receive after surgery. Andrews ,et
al’s (2022) retrospective cohort study design at a
single institution found a high incidence of
postoperative falls in the first 6 weeks after
foot and ankle surgery. They underscored that
baseline antidepressant uses and higher 2-week VAS
pain scores were associated with post-operative
falls. It is acknowledged that there are check-
lists for inpatient and nursing home residences.
My hope is that this revisiting of fall-
contributing adverse effects of the most
frequently prescribed drugs twenty-five years
later and the development of an electronic
predictive tool available to all healthcare
professions for all patient populations.
Bob Smith, DPM, MSc, RPh, Ormond Beach, FL
09/15/2025 Paul Kesselman, DPM
Increased Risk of Fatal Falls
A recent article in September 7, 2025 NY TImes
entitled Why Are More Older People Dying After
Falls, is a must read for every physician, no
matter their specialty. The NY Times article
points out a threefold increase in fatal falls
over the last thirty years. This compared to a
decreased or steady number of fatal falls per
capita in other countries.
The reason cited by both the NY Times and its
source is the increased reliance on Fall Risk
Increased Drugs(FRID) in the U.S. JAMA News while
a much lengthier read, provides a substantial
amount of statistical analysis and is the
foundation of the findings cited in the NY Times
article..
Having no other motive but to decrease falls in
our most fragile patients, it is imperative to
look into whether our elderly patients are at a
higher risk of falling due to taking FRID,
whether those medications are prescription or non-
prescription. Gabapentin,one FRID identified
prescription medication, often prescribed by
podiatrists and other physicians is often the go
to drug for chronic pain.
With the various initiatives to reduce opioid
dependency, Gabapentin (and similar medications)
are often used for patients with pain particularly
of a neurogenic etiology (e.g. diabetic
neuropathy, radiculopathy, etc.). They have all
been identified as FRID.
Many of our patients also take other FRID
including proton pump inhibitors, diazepines and
beta blockers. While those latter gabapentin
certainly is. Other medications used to treat
urinary frequency, OTC antihistamines for both as
a sleep aid and for allergy relief, with the
latter sometimes prescribed by podiatric
physicians are also on the list of FRID.
It is no wonder the US has seen an increase in
fatal falls over the past decade.
Adding to this fatality risk is the increased
reliance on various anticoagulants (direct and non
direct agents) for a variety of cardiovascular and
neurological issues, one has a recipe
for a fall in our elderly patients being the last
thing that happens to them.
Having known several relatives and relatives of
friends who lost loved ones due to a fatal fall
and perhaps due to FRID with anticoagulants, it is
imperative that any fall prevention discussion
brings up the FRID +anticoagulant issue. Speaking
with the doctors who have prescribed these
medications is mandatory.
I had my then 90+ year old dad's cardiologist
discontinue him from coumadin, because he had not
had an arrythmia for 7 years prior. He was simply
on it due to a previous one-time event. Was this a
rational reason or not? A discussion with the
cardiologist and my dad came to the conclusion
that while a risk, it was a risk worth taking.
He fell many times after that yet he never
sustained a life ending fall!. Who knows what
would have happened from the many times he struck
his head in subsequent falls?
Yes, addressing proper footwear, identifying other
issues requiring referral (e.g. ophthalmology and
visual impairment, neurology and neuromuscular
issues) and removing hazards from the home are
also important in particular for patients who are
at increased risk of falling and particularly for
those where a fall may be deadly. Patients living
alone are also at higher risk for falls and fatal
falls as well.
Enlisting social services, referral to physical
and occupational therapy and enlisting other
modalities are also prudent discussion points to
have with your patients and their caregivers.
There certainly may be times when an AFO and other
ambulatory assistive devices (cane, walker, etc)
may also be appropriate, but that should occur
only after a thorough fall risk assessment is
conducted and all the issues involved identified.
Prescriptions and orders for AFO and walker will
no doubt fail if the primary reason for the
patient's fall risks are not properly addressed.
Paul Kesselman, DPM, Oceanside, NY
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