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Cited by 517Balance, Gait, and Falls PreventionPharmaceutical Practices and Patient OutcomesFrailty in Older Adults

Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics

Open access
Seppala, Lotta J., Wermelink, Anne M.A.T., de Vries, Max, Ploegmakers, Kimberley J., van de Glind, Esther M.M., Daams, Joost G., van der Velde, Nathalie, Blain, Hubert +20 more·2018·Journal of the American Medical Directors Association
DOI 10.1016/j.jamda.2017.12.098
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Abstract

Background and objective Falls are a major public health problem in older adults. Earlier studies showed that psychotropic medication use increases the risk of falls. The aim of this study is to update the current knowledge by providing a comprehensive systematic review and meta-analysis on psychotropic medication use and falls in older adults.Methods and design This study is a systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were "falls," "aged," "medication," and "causality." Studies were included that investigated psychotropics (antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses were performed using generic inverse variance method pooling unadjusted and adjusted odds ratio (OR) estimates separately.Results In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses using adjusted data showed the following pooled ORs: antipsychotics 1.54 [95% confidence interval (CI) 1.28-1.85], antidepressants 1.57 (95% Cl 1.43-1.74), tricyclic antidepressants 1.41 (95% CI 1.07-1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85-2.20), benzodiazepines 1.42 (95%, CI 1.22-1.65), long-acting benzodiazepines 1.81 (95%, CI 1.05-3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04-1.56) Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and healthcare setting.Conclusions Antipsychotics, antidepressants, and benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Prescription bias could not be accounted for. Future studies need to address pharmacologic subgroups as fall risk may differ depending on specific medication properties. Precise and uniform classification of target medication (Anatomical Therapeutic Chemical Classification) is essential for valid comparisons between studies.

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  • In older adults, psychotropic use has been associated with risk of severe adverse effects such as falls, stroke and mortality.

    “In older adults, psychotropic use has been associated with the risk of severe adverse effects such as falls [13–18], stroke [17, 19–22] and mortality [13, 23–25].”

    From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [15]

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Authors
Seppala, L. J., Wermelink, A. M. A. T., de Vries, M., Ploegmakers, K. J., van de Glind, E. M. M., Daams, J. G., van der Velde, N., Blain, H., Bousquet, J., Bucht, G., Caballero-Mora, M. A., van der Cammen, T., Eklund, P., Emmelot-Vonk, M., Gustafson, Y., Hartikainen, S., Kenny, R. A., Laflamme, L., Landi, F., Masud, T., O'Byrne-Maguire, I., Petrovic, M., Rodriguez, L., Seppälä, L., Svensson, O., Szczerbińska, K., Thaler, H., & van der Velde, N.
Affiliations
Amsterdam UMC Location University of Amsterdam (NL)
ORCID
Venue
Journal of the American Medical Directors Association
Publisher
Elsevier BV
Published
2018-04
Volume
19
Issue
4
Pages
371.e11-371.e17
ISSN
1525-8610 (ISSN-L)
DOI
10.1016/j.jamda.2017.12.098
OpenAlex
W2793318154
Cited by
517
References
113
Citations by year
2026: 48 · 2025: 63 · 2024: 89 · 2023: 76 · 2022: 75 · 2021: 76 · 2020: 45 · 2019: 30 · 2018: 13 · 2017: 1
FWCI
7.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Medical Directors Association (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
fall risk, psychotropic drugs, older adults, antipsychotic drugs, antidepressants, benzodiazepines, selective serotonin reuptake inhibitors, tricyclic antidepressants, anxiolytics, sedatives, hypnotics, drug safety, fall risk factors, causality assessment, adverse drug reactions, falls in older adults, fall prevention
MeSH terms
Accidental Falls, Age Factors, Aged, Aged, 80 and over, Antidepressive Agents, Benzodiazepines, Female, Humans, Male, Middle Aged, Netherlands, Psychotropic Drugs, Sex Factors, Antipsychotic Agents, Geriatric Assessment, Prevalence, Risk Assessment

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