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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Winter, S. D., Vanwynsberghe, S., Foulon, V., Dejaeger, E. W., Flamaing, J., Sermon, A., der Linden, L. R. V., & Spriet, I. (2016) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-015-0230-0 · Cited by 16
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Associations of Guideline Recommended Medications for Acute Coronary Syndromes With Fall-Related Hospitalizations and Cardiovascular Events in Older Women With Ischemic Heart Disease
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Insomnia Symptom Frequency and Hypertension Risk: A Population-Based Study
Nc, I. (2014) · Cited by 15
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Result
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“Sex Men 6,234 (31) 6,234 (31) — Women 13,766 (69) 13,766 (69) —”
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Background
Antihypertensive Medications and Falls in the Elderly
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BackgroundMethod
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Quantifying cumulative anticholinergic and sedative drug load among US Medicare Beneficiaries
Shmuel, S., Pate, V., Pepin, M. J., Bailey, J. C., Hanson, L. C., Stürmer‎, T., Naumann, R. B., Golightly, Y. M., Gnjidic, D., & Lund, J. L. (2020) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.5144 · Cited by 15
Special Report from the CDC: Antidepressant Subclass Use and Fall Risk in Community-Dwelling Older Americans
Haddad, Y. K., Luo, F., Bergen, G., Legha, J., & Atherly, A. (2020) · Journal of Safety Research · doi:10.1016/j.jsr.2020.11.008 · Cited by 13
A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis
Huang, R. J., Smith, S. L., Brezina, L., & Riska, K. M. (2021) · American Journal of Audiology · doi:10.1044/2021_aja-21-00086 · Cited by 14
Danish register-based study on the association between specific antipsychotic drugs and fractures in elderly individuals
Torstensson, M., Leth-Møller, K., Andersson, C., Torp-Pedersen, C. T., Gislason, G., & Holm, E. (2016) · Age and Ageing · doi:10.1093/ageing/afw209 · Cited by 14
Concomitant alcohol and sedative-hypnotic drug use among the elderly in Norway
Bye, E. K., & Rossow, I. M. (2017) · Nordic Studies on Alcohol and Drugs · doi:10.1177/1455072516683896 · Cited by 14
“…nervous system (CNS) depression, leading to drowsiness and increased risk of falls and other accidental injuries in elderly people (Hartikainen, Lönnroos, & Louhivuori, 2007; Woolcott et al., 2009), which themselves are often accompanied by medical complications, care needs and loss of wellbeing.”
Background
Self-perception of fracture risk: what can it tell us?
Global Longitudinal Study of Osteoporosis in Women (GLOW) Investigators, Litwic, A., Compston, J. E., Wyman, A., Siris, E. S., Gehlbach, S. H., Adachi, J. D., Chapurlat, R. D., Díez‐Pérez, A., LaCroix, A. Z., et al. (2017) · Osteoporosis International · doi:10.1007/s00198-017-4200-3 · Cited by 14
“citonin, PTH [1-84], teriparatide, raloxifene or tibolone.”
Benzodiazepine use risk: Understanding patient specific risk perceptions and medication beliefs
Sake, F., WONG, K. K. H., Bartlett, D. J., & Saini, B. (2018) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2018.12.007 · Cited by 14
The Basis for Improving and Reforming Long-Term Care. Part 4: Identifying Meaningful Improvement Approaches (Segment 2)
Levenson, S. A. (2010) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2009.12.082 · Cited by 14
Modification of Potentially Inappropriate Prescribing Following Fall-Related Hospitalizations in Older Adults
Walsh, M. E., Boland, F., Moriarty, F., & Fahey, T. P. (2019) · Drugs & Aging · doi:10.1007/s40266-019-00646-z · Cited by 14
The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center
Walker, B. S., Collier, B. R., Bower, K. L., Lollar, D. I., Faulks, E. R., Matos, M. A., Nussbaum, M. S., & Hamill, M. E. (2019) · The American Surgeon · doi:10.1177/000313481908500842 · Cited by 14
Pregabalin and injury: A nested case‐control and case‐crossover study
Miyamoto, Y., Iwagami, M., Aso, S., Matsui, H., Doi, K., & Yasunaga, H. (2020) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4976 · Cited by 14
“With respect to covariates, we defined the use of drugs that are known risk factors for related injury in the same way as exposure to pregabalin: antidiabetic drugs (WHO-ATC code A10), antihypertensive drugs (C02, C03, C07, C08, and C09), opioids (N02A), antiepileptic drugs (N03), hypnotics (N05B), anti-Parkinson dise…”
Method
The predictive validity of a modified Japanese Nursing Association fall risk assessment tool: A retrospective cohort study
Higaonna, M. (2015) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2015.05.009 · Cited by 14
Medication Assessments by Care Managers Reveal Potential Safety Issues in Homebound Older Adults
Golden, A. G., Qiu, D., & Roos, B. A. (2011) · Annals of Pharmacotherapy · doi:10.1345/aph.1p643 · Cited by 14
Repetitive Traumatic Brain Injury Among Older Adults
Chauhan, A. V., Guralnik, J. M., dosReis, S., Sorkin, J. D., Badjatia, N., & Albrecht, J. S. (2021) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000719 · Cited by 13
Effects of tendon vibration and age on force reproduction task performed with wrist flexors
Henry, M., Eşrefoğlu, A., Duchateau, J., & Baudry, S. (2022) · Experimental Brain Research · doi:10.1007/s00221-022-06311-z · Cited by 13
“Individuals with Parkinson's disease, multiple sclerosis, diabetes, stroke, cardiac history or neurological damage, taking medications that could influence motor control [sedatives, hypnotics, antidepressants and benzodiazepines (Woolcott et al. 2009)] or suffering from orthopaedic problems could not participate to th…”
Background
Safety and effectiveness of benzodiazepines and antipsychotics for agitation in older adults in the emergency department
Engstrom, K., Mattson, A. E., Mara, K. C., Silva, L. O. J. E., Bellolio, F., Jeffery, M. M., Stanich, J. A., & Brown, C. S. (2023) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2023.02.032 · Cited by 13
Insomnia in primary care: Considerations for screening, assessment, and management
Yamamoto, M., Lim, C. T., Huang, H., Spottswood, M., & Huang, H. Y. (2023) · The Journal of Medicine Access · doi:10.1177/27550834231156727 · Cited by 16
Withdrawal of antihypertensive drugs in older people
Gnjidic, D., Langford, A. V., Jordan, V., Sawan, M. J., Sheppard, J. P., Thompson, W., Todd, A., Hopper, I., Hilmer, S. N., & Reeve, E. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012572.pub3 · Cited by 13
“Woolcott 2009 Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons.”
Antipsychotic Drug Treatment in Ambulatory Dementia Care: Prevalence and Correlates
Eichler, T. S., Wucherer, D., Thyrian, J. R., Kilimann, I., Hertel, J., Michalowsky, B., Teipel, S. J., & Hoffmann, W. U. (2014) · Journal of Alzheimer s Disease · doi:10.3233/jad-141554 · Cited by 13
“While antipsychotic drugs have only a limited effect on reducing neuropsychiatric symptoms, they cause severe side effects [14,16–19].”
Background
Medications in Long-Term Care: When Less is More
Meeks, T. W., Culberson, J. W., & Horton, M. S. (2011) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2011.01.003 · Cited by 17
Measuring psychotropic drug exposures in register‐based studies – validity of a dosage assumption of one unit per day in older Finns
Rikala, M., Hartikainen, S. A., Saastamoinen, L., & Korhonen, M. J. (2013) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1384 · Cited by 13
Psychotropics and weak opioid analgesics in plasma samples of older hip fracture patients – detection frequencies and consistency with drug records
Waade, R. B., Molden, E., Martinsen, M. I., Hermann, M., & Ranhoff, A. H. (2017) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.13244 · Cited by 13
Incident Use of a Potentially Inappropriate Medication and Hip Fracture in Community-Dwelling Older Persons With Alzheimer’s Disease
Hyttinen, V., Taipale, H. T., Tolppanen, A., Tanskanen, A. J., Tiihonen, J., Hartikainen, S. A., & Valtonen, H. J. (2017) · Annals of Pharmacotherapy · doi:10.1177/1060028017708394 · Cited by 13
“Definitions of potentially inappropriate medications (PIMs) include many fall-risk-increasing drugs.(6,7) PIMs are medications that likely cause more harm than benefits in older persons.”
Background
The relation between falls and medication use among elderly in assisted living facilities
Hamza, S. A., Adly, N. N., Abdelrahman, E. E., & Fouad, I. M. (2019) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4775 · Cited by 13
Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol
Correa-Pérez, A., Delgado‐Silveira, E., Martín‐Aragón, S., & Cruz-Jentoft, A. J. (2019) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098619868640 · Cited by 13
Potentially inappropriate benzodiazepine use in Australian adults: A population‐based study (2014–2017)
Zheng, D., Brett, J., Daniels, B. J., Buckley, N. A., Pearson, S., & Schaffer, A. L. (2020) · Drug and Alcohol Review · doi:10.1111/dar.13086 · Cited by 13
Acute Psychogeriatric Inpatient Treatment Improves Neuropsychiatric Symptoms but Impairs the Level of Functioning in Patients with Dementia
Alanen, H., Pitkänen, A., Suontaka-Jamalainen, K., Kampman, O., & Leinonen, E. V. J. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000431087 · Cited by 13
Preventing falls and fractures in long-term care
Wallis, S., & Campbell, G. A. (2011) · Reviews in Clinical Gerontology · doi:10.1017/s0959259811000104 · Cited by 14
Patterns of drug prescriptions in an orthogeriatric ward as compared to orthopaedic ward: results from the Trondheim Hip Fracture Trial—a randomised clinical trial
Heltne, M., Saltvedt, I. T., Lydersen, S., Prestmo, A., Sletvold, O., & Spigset, O. (2017) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-017-2263-x · Cited by 13
“Therefore, drugs that potentially affect cognition and may contribute to falls are of specific interest, such as drugs with potential anticholinergic side effects, cardiovascular drugs and drugs acting on the central nervous system [19, 20].”
Background
Association rules method and big data: Evaluating frequent medication combinations associated with fractures in older adults
Nishtala, P. S., Chyou, T., Held, F. P., Couteur, D. G. L., & Gnjidic, D. (2018) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.4432 · Cited by 13
Medication-related inpatient falls: a critical review
Ribeiro, T. B., de Melo, D. O., Maia, F. D. O. M., & Ribeiro, E. (2018) · Brazilian Journal of Pharmaceutical Sciences · doi:10.1590/s2175-97902018000117355 · Cited by 13
Anticoagulation quality and clinical outcomes in multimorbid elderly patients with acute venous thromboembolism
Lange, N. F., Méan, M., Stalder, O., Limacher, A., Tritschler, T., Rodondi, N., & Aujesky, D. (2019) · Thrombosis Research · doi:10.1016/j.thromres.2019.02.017 · Cited by 13
Antidepressants in the elderly.
Lindblad, A. J., Clarke, J., & Lu, S. (2019) · Europe PMC (PubMed Central) · Cited by 13
Medications and fall risk: a case–control study in nursing home residents in Japan
Park, H., Satoh, H., Miki, A., Maki, H., Asai, K., Shiraishi, A., Urushihara, H., & Sawada, Y. (2019) · Aging Clinical and Experimental Research · doi:10.1007/s40520-019-01265-9 · Cited by 13
Gait and Balance Disorder in Patients with Transient Ischemic Attack or Minor Stroke
Li, N., Li, J., Gao, T., Wang, D., Du, Y., & Zhao, X. (2021) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s289158 · Cited by 13
“Findings by Bloch and Woolcott JC both showed that gait and balance function may be influenced by combined use of multiple drugs, especially psychotropic medication.(32,33) Good control of vascular risk factors and rational prescription of medications remains important to patient health and prognosis.”
Background
Is the History of Falls an Indicative of Greater Decline in Quadriceps Muscle Function and Postural Sway?
Ribeiro, A. M. P., Gomes, M. M., Rosa, R. C., & de Abreu, D. C. C. (2012) · Topics in Geriatric Rehabilitation · doi:10.1097/tgr.0b013e318249a4f5 · Cited by 13
Falls and Depression in Men: A Population-Based Study
Stuart, A. L., Pasco, J. A., Jacka, F. N., Berk, M., & Williams, L. J. (2015) · American Journal of Men s Health · doi:10.1177/1557988315609111 · Cited by 13
Prescription patterns of first‐ and second‐generation antipsychotic drugs in the French population
Kovess‐Masfety, V., Balusson, F., Leray, E., Husky, M., & Scailteux, L. (2020) · Fundamental & Clinical Pharmacology · doi:10.1111/fcp.12553 · Cited by 12
Impaired Oral Health in Older Orthopaedic In-Care Patients: The Influence of Medication and Morbidity
Andersson, P., & Ekstam, A. K. (2021) · Clinical Interventions in Aging · doi:10.2147/cia.s326095 · Cited by 12
Benzodiazepine in der Geriatrie
Hofmann, W. E. (2013) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-013-0551-3 · Cited by 12
Falls in the stationary for patients with cardiovascular diseases of the senior age and polypharmacy
Ilina, E. S., Bogova, O. T., Sinitsina, I. I., Puzin, S. N., & Sychev, D. A. (2018) · Neuromuscular Diseases · doi:10.17650/2222-8721-2018-8-3-19-27 · Cited by 12
“Геронтологические общества наряду с регуляторными органами здравоохранения разных стран рекомендуют проведение лекарственного аудита для снижения количества назначенных ЛС как одного из возможных методов профилактики падений у пациентов старших возрастных групп [13, 14, 27, 28].”
Systematic Review of Benzodiazepines for Anxiety Disorders in Late Life
Gupta, A., Bhattacharya, G., Farheen, S. A., Funaro, M. C., Balasubramaniam, M., Young, J. J., Tampi, D. J., & Tampi, R. R. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200214 · Cited by 12
Effects of anticholinergic and sedative medication use on fractures: A self‐controlled design study
Shmuel, S., Pate, V., Pepin, M. J., Bailey, J. C., Golightly, Y. M., Hanson, L. C., Stürmer‎, T., Naumann, R. B., Gnjidic, D., & Lund, J. L. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17377 · Cited by 12

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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