Drug treatment as a cause of falls in old age. A review of the offending agents.

There are a number of ways in which drugs might increase the risk of an elderly person falling. The most important of these are sedation, impaired balance and reaction time, hypotension and drug-induced Parkinson's disease. Demonstrating the association between drugs and falls has been difficult because of certain methodological problems. However, there is now strong evidence that the use of psychotropic drugs, with the possible exception of short-acting benzodiazepines and hypnotics, is associated with a clinically important increase in the risk of falling. This increased risk is present after controlling for confounding factors such as confusion and depression. The evidence linking other drug groups to an increased risk of falls is conflicting. Decreasing the risk of drug-induced falls requires both careful individual adjustment of therapy and also a public health programme to ensure safe drug prescribing for older people.