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Clinician Article

Meta-analysis of the impact of 9 medication classes on falls in elderly persons.



  • Woolcott JC
  • Richardson KJ
  • Wiens MO
  • Patel B
  • Marin J
  • Khan KM, et al.
Arch Intern Med. 2009 Nov 23;169(21):1952-60. doi: 10.1001/archinternmed.2009.357. (Review)
PMID: 19933955
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Disciplines
  • FM/GP/Mental Health
    Relevance - 7/7
    Newsworthiness - 5/7
  • Geriatrics
    Relevance - 7/7
    Newsworthiness - 4/7
  • Hospital Doctor/Hospitalists
    Relevance - 7/7
    Newsworthiness - 4/7
  • Internal Medicine
    Relevance - 7/7
    Newsworthiness - 4/7
  • Cardiology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Rheumatology
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 4/7
  • Psychiatry
    Relevance - 6/7
    Newsworthiness - 4/7
  • Emergency Medicine
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

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); beta-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 beta-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.


Clinical Comments

Emergency Medicine

Useful for patient med reviews. Not helpful in making therapeutic choices in actual practice since falls are only one consideration to take. Perhaps helpful in ``primum non nocere`` if NOT prescribing a drug is an option.

Emergency Medicine

Emergency physicians frequently see the disastrous results of falls. The contribution of prescription medication use to these falls is often not appreciated. I suspect few physicians, including myself, reflect very often on their contribution to this problem. The increased risk of falling and the associated morbidity and mortality should be included in the mental risk/benefit analysis undertaken prior to prescribing medication. Even when the medication is essential, steps may be taken to mitigate their side effects. Primum non nocere.

Family Medicine (FM)/General Practice (GP)

Confirms what we already know. Few, if any, practitioners would read it.

FM/GP/Mental Health

Useful and practical evidence-based information that will allow clinicians to make better risk-benefit decisions when considering, prescribing and reviewing medications for elderly patients.

Geriatrics

Nothing really new. Just confirmation of what is already known.

Geriatrics

Well-designed and conducted meta-analysis. However, most geriatricians may already recognize well the association between the listed medications and fall risk. Investigating the impact of a single medication may not be relevant since many older patients take multiple medications. I would be more interested in the degree to which these medications in combination affect fall risk.

Psychiatry

Although the subject is very relevant, the article limits its practical use by only reporting odds ratios. A discussion on the absolute risk of falling when using different kinds of medications is missing.

Rheumatology

This article reviews a broad base of information for us on falls and medication. This is something that is good to know, but not information I would have actively sought out.

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