This Article  • Full text  • PDF  • Correction  • CME Course for This Article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (6)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Psychiatry  • Depression  • Psychopharmacology  • Public Health  • Injury Prevention & Control  • Quality of Care  • Evidence-Based Medicine  • Review  • Drug Therapy  • Adverse Effects  • Alert me on articles by topic  Social Bookmarking   What's this?

John C. Woolcott, MA; Kathryn J. Richardson, MSc; Matthew O. Wiens, BSc, Pharm, PharmD; Bhavini Patel, MPharm; Judith Marin, BPharm, PharmD; Karim M. Khan, MD, PhD; Carlo A. Marra, BSc, Pharm, PharmD, PhD

Arch Intern Med. 2009;169(21):1952-1960.

Background  There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis.

Methods  Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs)

Results  Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); β-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for β-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment.

Conclusion  The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.

Author Affilations: Faculty of Pharmaceutical Sciences (Mr Woolcott and Drs Wiens and Marra) and Department of Family Practice (Dr Khan), University of British Columbia, Collaboration for Outcomes Research and Evaluation (Mr Woolcott, Ms Richardson, and Dr Marra), Centre for Health Evaluation and Outcome Sciences (Mr Woolcott and Dr Marra), and Centre for Hip Health and Mobility, Vancouver Coastal Research Institute (Mr Woolcott and Drs Khan and Marra), Vancouver, Canada; School of Pharmacy, University of London, London, England (Ms Patal); and Fraser Health Authority Renal Program, Surrey, British Columbia, Canada (Dr Marin).

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Medication and Falls in Elderly Persons—Reply
John C. Woolcott, Kathryn J. Richardson, Karim M. Khan, and Carlo A. Marra
Arch Intern Med. 2010;170(9):835.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Risk for Fractures with Centrally Acting Muscle Relaxants: An Analysis of a National Medicare Advantage Claims Database
Golden et al.
The Annals of Pharmacotherapy 2010;44:1369-1375.
ABSTRACT | FULL TEXT  

Withdrawing antihypertensives on the basis of orthostatic hypotension
Choulerton et al.
Age Ageing 2010;39:518-518.
FULL TEXT  

Medication and Falls in Elderly Persons
Lesser
Arch Intern Med 2010;170:834-835.
FULL TEXT  

Medication and Falls in Elderly Persons--Reply
Woolcott et al.
Arch Intern Med 2010;170:835-835.
FULL TEXT  

Use of sedatives and hypnotics, antidepressants and benzodiazepines in older people significantly increases their risk of falls
Hartikainen and Lonnroos
Evid. Based Med. 2010;15:59-59.
FULL TEXT  

The Patient Who Falls: "It's Always a Trade-off"
Tinetti and Kumar
JAMA 2010;303:258-266.
ABSTRACT | FULL TEXT