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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).

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