Prescribing gabapentinoids, like gabapentin, has become increasingly common today, especially in older adults with chronic pain syndromes such as neuropathic pain. Marketed as a safer alternative to opioids, gabapentinoids may have contributed to a decrease in opioid prescribing—a positive step forward. However, gabapentinoids and fall risks in older adults must be carefully considered, as these medications come with adverse side effects.

Gabapentinoids can cause dizziness, gait disturbances, and balance disorders, all of which increase the risk of falls and fractures in older adults. Alarmingly, one in 25 people aged 80 years or older experiences a hip fracture each year, with one in four dying within 12 months. A recent case-case-time-control study of Australian adults hospitalized for first hip fracture found that gabapentinoid use was associated with a higher risk of hip fractures, especially in frail patients.

What can you do for your residents? If a resident is considered “frail” based on a frailty assessment, reconsider the use of gabapentinoids. This medication can significantly increase the risk of hip fractures in this subgroup. Not sure where your center stands on the use of gabapentinoids? It’s time to find out! Gather your team, request a pharmacy report identifying residents on this medication, and assess them individually. Be aware of the risks, weigh the benefits, and consider whether the risk is too great. Engage residents and their legal representatives in discussions about risk versus benefit to ensure informed decision-making.

Remember, first do no harm.

Stay well and stay informed!