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

The DOI matches its Crossref record; 54 of the 54 references it cites were found in a registry or an index.

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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“Most of the previous studies examining injuries and mental health have reported antidepressant medication to be a risk factor for injuries [28,29], while the results of this study were not similar.”
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“– Medications: cardiovascular drugs[2, 24] (b-blockers [1, 25, 26], antiarrhythmics [1, 5, 25], digoxin [1, 2, 5, 7], vasodilators [2, 5, 7, 8, 25], diuretics[1, 2, 5, 25, 26]), narcotic pain killers [1, 5, 6, 24–26], non-steroidal anti-inflammatory drugs (NSAI) [1, 5, 6, 25, 26], hypnotics [1, 6, 9, 24–28], antidepre…”
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BackgroundInfluential
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ResultInfluential
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Background
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Background
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“This is an important area to address, as use of hypnotics and sedatives has been associated with vehicle accidents (7), fallrelated injuries (8), cognitive decline (9), and mortality (10).”
A retrospective analysis of prescription medications as it correlates to falls for older adults
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“Moreover, empirical and clinical data show a clear relationship between the number and dosage of CNSADs for mobility limitations [67], falls [68, 69, 70], and fractures [71, 72]; however, we found no effect within ADRs measured with the Barthel index (BI).”
Background
DIZZINESS AND THE RISK OF FALLING IN THE ELDERLY: A LITERATURE REVIEW
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“5 Medication It is found in a great number of conducted research studies that elderly who are under medication of specific illness such as diabetes, psychotropic, ant-epileptics, and cardiovascular are far more in danger of fall incidents in virtue of medicine effects (Woolcott et al., 2009; Hartikainen et al., 2007;…”
Background
The New APGAR SCORE: A Checklist to Enhance Quality of Life in Geriatric Patients with Hip Fracture
Bernstein, J. M., Weintraub, S., Hume, E. L., Neuman, M. D., Kates, S. L., & Ahn, J. (2017) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.16.01149 · Cited by 9
Antipsychotic Drug Dispensations in Older Adults, Including Continuation After a Fall-Related Hospitalization: Identifying Adherence to Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria Using the Nova Scotia Seniors' Pharmacare Program and Canadian Institute for Health's Discharge Databases
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Management und Therapie des Vorhofflimmerns beim geriatrischen Patienten
Gosch, M., Roller, R. E., Böhmdorfer, B., Benvenuti-Falger, U., Iglseder, B., Lechleitner, M., Sommeregger, U., & Dovjak, P. (2012) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-011-0268-0 · Cited by 8
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“118 Wang and colleagues 119 ’ study of 1222 older adult patients found that benzodiazepine use is associated with increased risk of fractures after initiation of the medication, and this risk continues with chronic use as well.”
The impact of patient-facility language discordance on potentially inappropriate prescribing of antipsychotics in long-term care home in Ontario, Canada: a retrospective population health cohort study
Reaume, M., Peixoto, C., Pugliese, M., Tanuseputro, P., Batista, R., Kendall, C., Landry, J., Prud’homme, D., Chomienne, M., Farrell, B. J., et al. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-05446-8 · Cited by 8
“PIP-AP was defined according to the 2015 STOPP-START criteria (specifically criterion K2) [41], which identifies as potentially inappropriate the use of any neuroleptic (antipsychotic) medications, as they may cause gait dyspraxia or parkinsonism in the elderly [42, 43].”
Method
A meta-analysis of observational studies on anticholinergic burden and fracture risk: evaluation of conventional burden scales
Ogawa, Y., Hirai, T., & Mihara, K. (2021) · Journal of Pharmaceutical Health Care and Sciences · doi:10.1186/s40780-021-00213-y · Cited by 8
“Psychotropics, a typical class of anticholinergic drugs, are well known to cause falls [41].”
Background
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Oda, S., Takechi, K., Hirai, S., Takatori, S., & Otsuka, T. (2023) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-023-03485-5 · Cited by 8
“Hypnotic drugs have been reported as risk factors for falls [5].”
Background
Screening for orthostatic hypotension in the geriatric population in a real-world primary care setting reduces prescribed antihypertensive medications
Kaye, M. G., Rutowski, J., Aftab, H., Pandey, R., Khan, R., Kalot, M. A., Anand, R., & Graham, S. (2023) · Blood Pressure Monitoring · doi:10.1097/mbp.0000000000000673 · Cited by 8
“Falls are the number one cause of accidental trauma among individuals 65 and older, and studies have shown an association between antihypertensive medication use and fall risk in the geriatric population [8–10].”
Background
Rates of Non-vertebral Osteoporotic Fractures in Rheumatoid Arthritis and Postfracture Osteoporosis Care in a Period of Evolving Clinical Practice Guidelines
Roussy, J., Bessette, L., Bernatsky, S., Rahme, E., & Lachaîne, J. (2014) · Calcified Tissue International · doi:10.1007/s00223-014-9856-5 · Cited by 8
“As such, our fifth category of variables was composed of drugs known to increase the risk of fall (opioids, nonsteroidal anti-inflammatory drugs [NSAIDs], antidepressants, anxiolytics, and antipsychotics [15]) and drugs affecting the risk of fractures via an impact on bone remodeling (proton pomp inhibitors [16], sele…”
Background
Medications and the risk of falls among older people in a geriatric centre in Nigeria: a cross-sectional study
Akande‐Sholabi, W., Ogundipe, F. S., & Adebusoye, L. A. (2020) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-020-01140-y · Cited by 8
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Hamada, S., Kojima, T., Hattori, Y., Maruoka, H., Ishii, S., Okochi, J., & Akishita, M. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045787 · Cited by 8
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Living Conditions and the Incidence and Risk of Falls in Community-Dwelling Older Adults: A Multifactorial Study
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Result
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Li, S., Xue, Q., Zhong, Y., Liao, P., Ji, Q., Yang, X., Feng, X., Zhou, L., & Zhu, F. (2023) · Medicine · doi:10.1097/md.0000000000034346 · Cited by 9
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Therapie mit Antipsychotika und Antidepressiva bei Demenzen
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Background
Medicine Use among Older Australians Before and After Hip Fracture
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Schwabe, J., Caughey, G. E., Jorissen, R. N., Comans, T. A., Gray, L., Westbrook, J. I., Braithwaite, J., Hibbert, P. D., Wesselingh, S. L., Sluggett, J. K., et al. (2024) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzae105 · Cited by 7
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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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