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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Summary of factors contributing to falls in older adults and nursing implications
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“The use of sedatives and hypnotics, such as the benzodiazepines as well as anti-depressants, has been shown to have the strongest associations with falling and fall-related injuries [14].”
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Arousal, valence and their relative effects on postural control
Horslen, B. C., & Carpenter, M. G. (2011) · Experimental Brain Research · doi:10.1007/s00221-011-2867-9 · Cited by 103
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“The use of sedatives/hypnotics, neuroleptics, anticholinergic drugs, antihypertensive drugs (beta-blockers, ACE inhibitors, calcium-channel blockers) and diuretics (thiazide and loop diuretics) was included as risk factors, based on the results of previous meta-studies [27,37-39].”
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“They are associated with increased risk of falls and fracture.(38,39) Benzodiazepines are also implicated in the development of cognitive dysfunction and increasing the risk of dementia.”
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The reappraisal of benzodiazepines in the treatment of anxiety and related disorders
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“Along with advancing age, these conditions 14,15,24,25 and the medications used to treat them 26,27 can reduce older adults’ functional abilities and increase their risk of falling.”
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Background
Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review
Gebara, M. A., Lipsey, K. L., Karp, J. F., Nash, M. C., Iaboni, A., & Lenze, E. J. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.11.004 · Cited by 85
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Research Design in Clinical Psychology
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Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly
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“8) [3,15,16].”
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Background
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Background
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Background
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Background
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“drugs are some of the medications that are known to be associated with increased falls in elderly people [6].”
Background
Patterns of Prescription Drug Use Before and After Fragility Fracture
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Background
Polypharmacy is Associated with an Increased Risk of Bleeding in Elderly Patients with Venous Thromboembolism
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Effects of short-term training combining strength and balance exercises on maximal strength and upright standing steadiness in elderly adults
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Intensive Blood Pressure Control, Falls, and Fractures in Patients with Type 2 Diabetes: The ACCORD Trial
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Polypharmacy, Gait Performance, and Falls in Community‐Dwelling Older Adults. Results from the Gait and Brain Study
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Is It Possible to Identify Risks for Injurious Falls in Hospitalized Patients?
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Reexamining the Effect of Antihypertensive Medications on Falls in Old Age
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“183 Several studies have suggested that there is an increased risk of falls in elderly people taking antihypertensive medications.(1,2) A recent observational study of 4961 hypertensive community-dwelling participants in the Medicare Current Beneficiary Survey showed an increased risk of injurious falls in those who r…”
Background
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Sedative-Hypnotic Medicines and Falls in Community-Dwelling Older Adults: A Cost-Effectiveness (Decision-Tree) Analysis from a US Medicare Perspective
Tannenbaum, C., Diaby, V., Singh, D. K., Perreault, S., Luc, M., & Vasiliadis, H. (2015) · Drugs & Aging · doi:10.1007/s40266-015-0251-3 · Cited by 71
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Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious Falls: A study in Nursing Home Residents with Dementia
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Accelerometer-based physical activity in a large observational cohort - study protocol and design of the activity and function of the elderly in Ulm (ActiFE Ulm) study
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“All of the drugs or drug categories listed are known to increase risk of older adults being admitted to an emergency department for either drugrelated adverse events or falls (Budnitz et al., 2007; Sikdar et al., 2010; Woolcot et al., 2009).”
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Psychoactive Medications Increase the Risk of Falls and Fall-related Injuries in Hospitalized Patients With Cirrhosis
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Result
High Prevalence of Inappropriate Benzodiazepine and Sedative Hypnotic Prescriptions among Hospitalized Older Adults
Pek, E., Remfry, A., Pendrith, C., Fan‐Lun, C., Bhatia, R. S., & Soong, C. (2017) · Journal of Hospital Medicine · doi:10.12788/jhm.2739 · Cited by 59
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Long-term use of zolpidem increases the risk of major injury: a population-based cohort study
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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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