Older Adults: Falls, Kidney Function and Keeping a Medicine List

Call 911 for a fall with a head injury and confusion or drowsiness, collapse, chest pain, trouble breathing, or swelling of the face or throat. For a possible poisoning or too many pills, call Poison Help at 1-800-222-1222 (US).

Older adults often take several medicines, and many also use vitamins, herbs or other supplements. The question this page answers is why age changes the picture, and what a person can do about it. It is information only. Your prescriber and pharmacist know your medicines and kidney tests.

Why age matters

MedlinePlus says that with age "the amount of kidney tissue decreases and kidney function diminishes", and that this "causes the kidneys to filter blood more slowly." [1] It also says "illness, medicines, and other conditions can significantly degrade kidney function." [1] Because kidneys help clear many substances, a medicine or supplement may behave differently when they work more slowly. The sources we read do not give a rule for any single herb; that is a question for a pharmacist or kidney clinician. See kidney disease and supplements and multiple medicines, kidney function and supplement burden.

NIDDK's page on chronic kidney disease says to talk with your provider "about all the medicines you take, including OTC medicines, vitamins, and supplements." [2] It adds that some medicines "can also harm your kidneys" and that NSAIDs, a group of common pain relievers, "can damage your kidneys." [2] (Reviewed October 2016; the page does not mention herbal products.)

Falls and medicines

CDC's STEADI fact sheet (2017) says to review medications with all patients 65 and older, and lists medicine groups linked to falls: anticonvulsants, antidepressants, antipsychotics, benzodiazepines, opioids and sedative-hypnotics. [3] It also says to "review prescription drugs, over-the-counter medications, and herbal supplements," because some "can cause dizziness, sedation, confusion, blurred vision, or orthostatic hypotension" (a drop in blood pressure on standing). [3] It names anticholinergics, antihistamines, medications affecting blood pressure and muscle relaxants among those. [3] MedlinePlus likewise says "taking certain medicines can also increase the risk for falls." [4]

"Proper evidence not found": we looked in the CDC, NIA and MedlinePlus pages above for a statement linking a particular named herb to falls in older adults, and found only the general statement about herbal supplements. That is not proof that no herb contributes; ask a pharmacist about the products you use. See falls and balance problems and vitamin D, bone health, falls and fractures.

Never stop, skip or change a prescribed medicine on your own because of a page like this; ask the prescriber or pharmacist.

Using a Beers-type list

The American Geriatrics Society Beers Criteria (2023 update) is "an explicit list of PIMs [potentially inappropriate medications] that are typically best avoided by older adults in most circumstances or under specific situations." [5] It applies to adults 65 and older and "should be applied thoughtfully and in a manner that supports, rather than replaces, shared clinical decision-making." [5] It is a tool for clinicians. The abstract we read does not discuss herbal supplements.

Supplements and older adults: what NIA says

NIA's Dietary Supplements for Older Adults AgePage (April 2021) says supplements "can be beneficial at any age" but "can also have unwanted side effects, such as unsafe prescription drug interactions." [6] It says a "natural" label does not mean a product is safe, and that a supplement "could make a medicine your doctor prescribed for you either weaker or stronger." [6] It adds that researchers are looking at herbal supplements, "but it's too early to know if these are both safe and useful." [6]

On regulation, NIA says the FDA "does not have authority over dietary supplements" to approve them for safety or efficacy before sale, and that being on a store shelf "does not mean it is safe, does what the label says it will, or contains what the label states." [6] NCCIH notes older adults having swallowing problems from large vitamin pills. [7] For nutrient-specific advice see vitamins and supplements for older adults.

Keep one medicine list

MedlinePlus advises: "Keep a list of all medicines you take", noting that over-the-counter medicines "include vitamins, supplements, and herbal products." [4] It says to discuss the list with your provider each time you have an appointment, and to review it with providers and pharmacists. [4] NIA's AgePage says to bring a completed, updated medicine form to every appointment. [6] MedlinePlus lists people prescribed 5 or more medicines as facing a higher chance of interactions or side effects. [4]

A good list includes the product type, what it is for, who recommended it, and the label's ingredient list. For tools and questions see questions to ask your pharmacist, medication interactions and anesthesia and herbal supplements. Before surgery, tell the surgical and anesthesia team about everything on the list.

Who should ask first

Anyone with kidney disease, a long medicine list, a history of falls, or a medicine with a narrow safety range (see narrow therapeutic index medicines) should ask a pharmacist before adding any herb or supplement. For the broader picture see older adults: more medicines, more interactions.