BACKGROUND: Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. METHODS: Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged ≥65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. RESULTS: During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95% CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95% CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95% CI 1.02-1.71]), and antidepressant use (HR 1.40 [95% CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. CONCLUSION: Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.
RCT Entities:
BACKGROUND: Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. METHODS: Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged ≥65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. RESULTS: During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95% CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95% CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95% CI 1.02-1.71]), and antidepressant use (HR 1.40 [95% CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. CONCLUSION: Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.
Authors: John C Woolcott; Kathryn J Richardson; Matthew O Wiens; Bhavini Patel; Judith Marin; Karim M Khan; Carlo A Marra Journal: Arch Intern Med Date: 2009-11-23
Authors: George Liamis; Eline M Rodenburg; Albert Hofman; Robert Zietse; Bruno H Stricker; Ewout J Hoorn Journal: Am J Med Date: 2013-01-18 Impact factor: 4.965
Authors: Magnus K Karlsson; Thord Vonschewelov; Caroline Karlsson; Maria Cöster; Björn E Rosengen Journal: Scand J Public Health Date: 2013-04-03 Impact factor: 3.021
Authors: K M A Swart; A W Enneman; J P van Wijngaarden; S C van Dijk; E M Brouwer-Brolsma; A C Ham; R A M Dhonukshe-Rutten; N van der Velde; J Brug; J B J van Meurs; L C P G M de Groot; A G Uitterlinden; P Lips; N M van Schoor Journal: Eur J Clin Nutr Date: 2013-05-22 Impact factor: 4.016
Authors: Klaas A Hartholt; Nicole D A Boyé; Nathalie Van der Velde; Esther M M Van Lieshout; Suzanne Polinder; Oscar J De Vries; Albert J H Kerver; Gijsbertus Ziere; Milko M M Bruijninckx; Mark R De Vries; Francesco U S Mattace-Raso; André G Uitterlinden; Ed F Van Beeck; Paul Lips; Peter Patka; Tischa J M Van der Cammen Journal: BMC Geriatr Date: 2011-08-21 Impact factor: 3.921
Authors: Annelies C Ham; Suzanne C van Dijk; Karin M A Swart; Anke W Enneman; Nikita L van der Zwaluw; Elske M Brouwer-Brolsma; Natasja M van Schoor; M Carola Zillikens; Paul Lips; Lisette C P G M de Groot; Albert Hofman; Renger F Witkamp; André G Uitterlinden; Bruno H Stricker; Nathalie van der Velde Journal: Br J Clin Pharmacol Date: 2017-07-04 Impact factor: 4.335
Authors: A C Pronk; L J Seppala; K Trajanoska; N Stringa; B van de Loo; L C P G M de Groot; N M van Schoor; F Koskeridis; G Markozannes; E Ntzani; A G Uitterlinden; F Rivadeneira; B H Stricker; N van der Velde Journal: PLoS One Date: 2022-04-14 Impact factor: 3.752
Authors: Maartje H de Groot; Jos P C M van Campen; Nienke M Kosse; Oscar J de Vries; Jos H Beijnen; Claudine J C Lamoth Journal: PLoS One Date: 2016-02-22 Impact factor: 3.240
Authors: L Vranken; C E Wyers; R Y Van der Velde; H M Janzing; S Kaarsemaker; P P Geusens; J P Van den Bergh Journal: Osteoporos Int Date: 2017-11-23 Impact factor: 4.507