Cited by 1,326Pharmaceutical Practices and Patient OutcomesBalance, Gait, and Falls PreventionFrailty in Older Adults

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Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons

Woolcott, John C.·2009·Archives of Internal Medicine

DOI 10.1001/archinternmed.2009.357

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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.

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“Mehrere Untersuchungen befassten sich mit der Frage nach Zusammenhängen zwischen Benzodiazepin-Einnahme und Stürzen mit und ohne nachfolgende Schenkelhalsfraktur [1][16][17][19].”
Background
The experience of dissolving polypharmacy by reducing the prescription of anti-ulcer drugs in residents of a special geriatric nursing home
Okada, K., Yamaguch, Y., Kamada, N., Okada, M., Katoh, S., & Sasaki, H. (2016) · Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics · doi:10.3143/geriatrics.53.396 · Cited by 1
Imbalance and Falls in Older Cancer Survivors
Hile, E. S. (2015) · Topics in Geriatric Rehabilitation · doi:10.1097/tgr.0000000000000079 · Cited by 1
Rehabilitation After Hip Fracture
Dionyssiotis, Y. (2017) · Springer eBooks · doi:10.1007/978-3-319-54016-0_14 · Cited by 1
Pharmakotherapie bei Alterspatienten
Hiemke, C., & Hefner, G. (2017) · Springer eBooks · doi:10.1007/978-3-662-53697-1_12 · Cited by 1
Schlafstörungen bei alten Menschen
Frohnhofen, H., & Netzer, N. C. (2017) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-017-1329-9 · Cited by 1
“Daraus folgt, dass die Bewertung einer Hypnotikatherapie im Rahmen des Sturzrisikoassessments viel differenzierter erfolgen muss [31, 35, 37].”
The correlation of specific medication groups and falls risk in elderly. A medication logbook survey
Pyrgeli, M., Agapiou, E., Pyrgelis, E.-S., Manaras, D., Dionyssiotis, Y., & Dontas, I. A. (2017) · Journal of Frailty Sarcopenia and Falls · doi:10.22540/jfsf-02-092 · Cited by 1
Paradoxic effect of Benzodiazepines in geriatric population
Valdivieso-Jiménez, G. (2018) · MOJ Gerontology & Geriatrics · doi:10.15406/mojgg.2018.03.00118 · Cited by 1
Depression, Osteoporose, Stürze und Frakturen
Rapp, K., & Pfeiffer, K. (2019) · Osteologie/Osteology · doi:10.1055/a-0999-9866 · Cited by 1
“Die Metaanalyse von Woolcott zeigte für Antidepressiva ein um 70 % erhöhtes Sturzrisiko [25].”
Background
Falls and Hypotensive Syndromes in the Elderly
Alagiakrishnan, K. (2019) · Springer eBooks · doi:10.1007/978-3-030-30332-7_16 · Cited by 1
Rethinking potentially inappropriate medication use in nursing homes within the Chinese population
Lin, Y., Tsai, H., Huang, H., Chang, Y., & Shieh, W. (2020) · Geriatric Nursing · doi:10.1016/j.gerinurse.2020.05.001 · Cited by 1
Orthostatic hypotension. Part 2: diagnosis and treatment
Golovina, G., Николаевна, Ж. О., Zargaryan, K. A., Kravchenko, O., & Tripolskaya, N. E. (2020) · Innovative medicine of Kuban · doi:10.35401/2500-0268-2020-19-3-77-85 · Cited by 2
From Benzodiazepine Prescription to Dependence: Learning Processes Involved
de la Villarmois, E. A., Constantin, M. F., & Pérez, M. F. (2021) · Springer eBooks · doi:10.1007/978-3-030-61721-9_19 · Cited by 1
Practical Strategies in Geriatric Mental Health
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372577 · Cited by 1
Pharmacy students knowledge about aging and rational geriatric pharmacotherapy in India: A cross-sectional study
Bhagavathula, A. S., Bandari, D. K., Areman, B. S., & Fialová, D. (2021) · Gerontology & Geriatrics Education · doi:10.1080/02701960.2021.1885397 · Cited by 1
“…independently increase the risk of falls in older people and cause hip fractures and motor vehicle accidents (Ballokova et al., 2014; Chang, Wu, Chang, & Lin, 2008; Chang et al., 2013; Hartikainen, Lönnroos, & Louhivuori, 2007; Pariente et al., 2008; Woolcott et al., 2009; Yu et al., 2017).”
Background
Prevention and screening
Birch, J. T., & Bhattacharya, S. B. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781107294967.004 · Cited by 1
Evidence Based Falls Management Program in the Nursing Home
Jacobs, D. (2014) · Cited by 1
Internal and External Validity
Kazdin, A. E. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108993647.003 · Cited by 1
Geriatric Neurotrauma
Wilberger, J. E. (2017) · Springer eBooks · doi:10.1007/978-3-319-48687-1_26 · Cited by 1
Depressive Störungen
Laux, G. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_67 · Cited by 2
Hospital-Wide Surveillance of Fracture Risk Assessment by Both FRAX and Medication Patterns in Acute Care Hospital
Tobe, T., Kubo, M., Toda, T., Morita, M., Mika, W., Yamada, S., Suzuki, A., & Hayashi, T. (2022) · Biological and Pharmaceutical Bulletin · doi:10.1248/bpb.b22-00017 · Cited by 1
“In the literature [30-35], medications associating with an increased risk of osteoporosis by reduction of BMD were identified as bone-related medicine (BRM) and included anticonvulsants, glucocorticoids, H2-receptor inhibitors, PPIs, and thiazolidinediones.”
Background
Pharmakotherapie und geriatrische Syndrome
Burkhardt, H. (2016) · Springer eBooks · doi:10.1007/978-3-662-48126-4_3 · Cited by 1
Adjunctive Medications
Freudenreich, O. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-29450-2_19 · Cited by 1
Effects of hospitalist co-management on rate of initiation of osteoporosis treatment in patients with vertebral compression fractures: Retrospective cohort study
Tsunemitsu, A., Tsutsumi, T., Inokuma, S., Kobayashi, T., & Imanaka, Y. (2022) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2022.09.013 · Cited by 1
Benzodiazepine Dose Intensity among Patients Concurrently Prescribed Buprenorphine in Rhode Island
Borrelli, E. P., Bratberg, J. P., Hallowell, B. D., & Kogut, S. J. (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2205492 · Cited by 1
Vestibular Disorders and Their Impact on Balance and Mobility
Majeed, S., Farooqi, S., & Jamshed, A. (2023) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs2023173686 · Cited by 1
Medications for Anxiety Disorders
Narita, Z. C., Fujimoto, M., Winter, E., Nestadt, P. S., & Sawa, A. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_136-1 · Cited by 1
Evaluation of Patient Outcomes after Pharmacological Intervention in Home Health Care Utilizing Pharmaceutical Care Records
Yanagisawa, Y., Yokokawa, Y., Kizaki, H., Sayama, K., Yokoyama, S., Sasaki, T., Someya, M., Taniguchi, R., Imai, S., & Hori, S. (2024) · YAKUGAKU ZASSHI · doi:10.1248/yakushi.24-00080 · Cited by 1
Reprint of: The impact of alpha-1-adrenergic receptor antagonists on the progression of Parkinson disease
Opheim, K. M., Uc, E. Y., Cantrell, M. A., & Lund, B. C. (2024) · Journal of the American Pharmacists Association · doi:10.1016/j.japh.2024.102173 · Cited by 1
Kindling in psychopharmacology: Unveiling an overlooked clinical challenge with significant implications
Maviglia, M. A., Cooeyate, N. J., Hume, D., & Guerra, L. (2024) · Journal of Psychology & Clinical Psychiatry · doi:10.15406/jpcpy.2024.15.00793 · Cited by 1
Understanding the Relationship Between Adverse Medication Use and Falls Among Older Patients Receiving Home Medical Care: OHCARE study
Murakami, N., Kabayama, M., Yano, T., Nakamura, C., Fukata, Y., Morioka, C., Fang, W., Nako, Y., Omichi, Y., Koujiya, E., et al. (2024) · Gerontology and Geriatric Medicine · doi:10.1177/23337214241291084 · Cited by 1
“…a possible reason related to the result of more falls in those with multiple medications (Moon & Mikami, 2009; The Japan Geriatrics Society, 2015; Woolcott et al., 2009) because antihypertensive medications cause hypotension, hypoglycemic medications might cause hypoglycemia, and hypnotic and…”
Manglande registrering av fall i sjukeheim
Øygard, S. H., Andersen, J. R., Sandvoll, A. M., & Ytrehus, S. (2017) · Sykepleien Forskning · doi:10.4220/sykepleienf.2017.62446 · Cited by 1
“Today we have a great deal of knowledge about factors that influence the risk of falling (7, 11, 12).”
Background
Ontwikkeling van algoritmes voor oordeelkundig gebruik van psychofarmaca bij ouderen met verhoogd valrisico
Geeraerts, A., Dilles, T., Foulon, V., Habraken, H., Petrović, M., Strauven, G., Tournoy, J., Vandeput, O., Wertelaers, A., Vlaeyen, E., et al. (2017) · Tijdschrift voor Gerontologie en Geriatrie · doi:10.1007/s12439-017-0229-1 · Cited by 1

Authors: Woolcott, J. C.
Affiliations: University of British Columbia (CA)
Corresponding author: Woolcott, John C.
ORCID: Woolcott, John C.
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2009-11-01
Volume: 169
Issue: 21
Pages: 1952
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinternmed.2009.357
OpenAlex: W2094113973
Cited by: 1,326
References: 54
Citations by year: 2026: 42 · 2025: 42 · 2024: 67 · 2023: 57 · 2022: 70 · 2021: 116 · 2020: 93 · 2019: 122 · 2018: 107 · 2017: 99 · 2016: 80 · 2015: 89 · 2014: 83 · 2013: 83 · 2012: 71
FWCI: 5.97
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords: falls in older adults, fall risk, antihypertensive drugs, diuretics, beta-blockers, sedative-hypnotic drugs, antidepressants, benzodiazepines, narcotics, nonsteroidal anti-inflammatory drugs, drug safety, fall prevention, geriatric pharmacology, polypharmacy
MeSH terms: Accidental Falls, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Antidepressive Agents, Bayes Theorem, Benzodiazepines, Cardiovascular Agents, Cross-Sectional Studies, Diuretics, Humans, Hypnotics and Sedatives, Narcotics, Risk Factors, Sensitivity and Specificity, Antipsychotic Agents, Odds Ratio, Case-Control Studies, Randomized Controlled Trials as Topic

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Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons

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