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Cited by 59Pharmaceutical Practices and Patient OutcomesCardiovascular Syncope and Autonomic DisordersBalance, Gait, and Falls Prevention

Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes

Van Der Velde, Nathalie, Van Den Meiracker, Anton H., Pols, Huibert A. P., Stricker, Bruno H. Ch., Van Der Cammen, Tischa J. M.·2007·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2007.01137.x
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Abstract

OBJECTIVES: To determine whether outcomes of tilt-table tests improved after withdrawal of fall-risk-increasing drugs (FRIDs). DESIGN: Prospective cohort study. SETTING: Geriatric outpatient clinic. PARTICIPANTS: Two hundred eleven new, consecutive outpatients, recruited from April 2003 until December 2004. MEASUREMENTS: Tilt-table testing was performed on all participants at baseline. Subsequently, FRIDs were withdrawn in all fallers in whom it was safely possible. At a mean follow-up of 6.7 months, tilt-table testing was repeated in 137 participants. Tilt-table testing addressed carotid sinus hypersensitivity (CSH), orthostatic hypotension (OH), and vasovagal collapse (VVC). Odds ratios (ORs) of tilt-table-test normalization according to withdrawal (discontinuation or dose reduction) of FRIDs were calculated using multivariate logistic regression analysis. RESULTS: After adjustment for confounders, the reduction of abnormal test outcomes (ORs) according to overall FRID withdrawal was 0.34 (95% confidence interval (CI)=0.06-1.86) for CSH, 0.35 (95% CI=0.13-0.99) for OH, and 0.27 (95% CI=0.02-3.31) for VVC. For the subgroup of cardiovascular FRIDs, the adjusted OR was 0.13 (95% CI=0.03-0.59) for CSH, 0.44 (95% CI=0.18-1.0) for OH, and 0.21 (95% CI=0.03-1.51) for VVC. CONCLUSION: OH improved significantly after withdrawal of FRIDs. Subgroup analysis of cardiovascular FRID withdrawal showed a significant reduction in OH and CSH. These results imply that FRID withdrawal can cause substantial improvement in cardiovascular homeostasis. Derangement of cardiovascular homeostasis may be an important mechanism by which FRID use results in falls.

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Crossref · 10.1111/j.1532-5415.2007.01137.x

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  • The prescription of polypharmacy, cardiovascular medications, and psychotropic and dopaminergic drugs increases the risk of syncope and falls.

    “The prescription of polypharmacy, cardiovascular medications, and psychotropic (neuroleptics and antidepressants) and dopaminergic drugs also increases the risk of syncope and falls. 381-385”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [381]

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Authors
Van Der Velde, N., Van Den Meiracker, A. H., Pols, H. A. P., Stricker, B. H. C., & Van Der Cammen, T. J. M.
Affiliations
Erasmus MC (NL)
ORCID
Stricker, Bruno H. Ch.
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2007-03-20
Volume
55
Issue
5
Pages
734-739
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2007.01137.x
OpenAlex
W2085939910
Cited by
59
References
37
Citations by year
2026: 1 · 2023: 2 · 2022: 3 · 2021: 1 · 2019: 1 · 2018: 6 · 2016: 6 · 2015: 5 · 2014: 5 · 2013: 4 · 2012: 2
FWCI
2.68
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Keywords
fall-risk-increasing drugs, drug withdrawal, older adults, tilt table test, carotid sinus hypersensitivity, orthostatic hypotension, falls, cardiovascular homeostasis, antihypertensive drugs
MeSH terms
Accidental Falls, Aged, Cardiovascular Agents, Carotid Sinus, Female, Humans, Hypotension, Hypotension, Orthostatic, Male, Psychotropic Drugs, Risk Factors, Syncope, Tilt-Table Test, Syncope, Vasovagal, Mobility Limitation

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