An update of a previous meta-analysis has found that several drug classes are significantly associated with an increased risk of falls in the elderly, with the clearest associations for sedatives and hypnotics, antidepressants, and benzodiazepines.
Falls and related complications are a major cause of mortality and morbidity in the elderly and result in huge costs to healthcare systems and societies, thus research on any factor that increases fall risk is important. Prescribed medications are recognised as a significant contribution to fall risk: this paper updates previous meta-analyses published on the topic in 1999. The authors carried out a comprehensive literature search covering April 1996 to August 2007 for any published studies in any language that examined the effects of prescribed medication on risk of falls. Eligible studies presented original data of randomized, controlled trial, case-control, cohort, or cross-sectional designs assessing the association between medication use and falls in persons aged 60 years or older.
Bayesian analysis was used so that the results of the previous meta-analysis could be combined with new information to estimate updated Bayesian odds ratios (OR) and 95% credible intervals (95% CrI). Nine drug classes were considered: antihypertensive agents; diuretics; beta-blockers; sedatives and hypnotics; neuroleptics and antipsychotics; antidepressants; benzodiazepines; narcotics; and non-steroidal anti-inflammatory drugs (NSAID).
The initial literature search identified 11,118 potentially eligible reports, of which 11,065 were excluded on title and abstract leaving 53 for further consideration. Of these, 31 were excluded (insufficient data or inappropriate design) to leave 22 (n=79,081)for analysis. All were observational, 10 cohort, 5 case-control, and 7 cross-sectional.
After consideration and updating of the results in the earlier meta-analysis, the strongest association between medication and falling was for antidepressive drugs, associated with about two-thirds increase in risk (OR, 1.68; 95% CrI, 1.47 to 1.91). Other psychotropic drugs were also associated with increased risk, including sedatives and hypnotics (OR, 1.47; 95% CrI, 1.35 to 1.62), and benzodiazepines (OR, 1.57; 95% CrI, 1.43 to 1.72). Neuroleptic and antipsychotic drugs were associated with increased risk in unadjusted results but the effect was no longer significant after adjustment for confounding factors. ‘Narcotics’ were least associated with risk (OR, 0.96; 95% CrI, 0.78 to 1.18).
Antihypertensive drugs were associated with a moderately increased risk (OR, 1.24; 95% CrI, 1.01 to 1.50), but associations for diuretics, beta-blockers, and NSAID were not significant.
The authors conclude that their analysis extends knowledge on the impact of these groups of prescription medicines on the risk of falling in older people. In particular, it confirms the increased risk associated with use of sedatives and hypnotics, antidepressants, and benzodiazepines in older people: these drugs should be prescribed with caution in this patient group.