Drugs and falls in older people: A systematic review and meta-analysis: II. Cardiac and analgesic drugs

Citation
Rm. Leipzig et al., Drugs and falls in older people: A systematic review and meta-analysis: II. Cardiac and analgesic drugs, J AM GER SO, 47(1), 1999, pp. 40-50
Citations number
72
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
Journal title
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
ISSN journal
00028614 → ACNP
Volume
47
Issue
1
Year of publication
1999
Pages
40 - 50
Database
ISI
SICI code
0002-8614(199901)47:1<40:DAFIOP>2.0.ZU;2-I
Abstract
OBJECTIVES: To evaluate critically the evidence linking specific classes of cardiac and analgesic drugs to falls in older people. DESIGN: Fixed-effects meta-analysis. DATA SOURCES: English-language articles in MEDLINE (1966 - March 1996) inde xed under accidents or accidental falls and aged or age factors; bibliograp hies of retrieved papers. STUDY SELECTION: Systematic evaluation of cardiac or analgesic drug use and any fall in people aged 60 years and older. DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, s ample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and nonfallers taking specific classes of cardiac and analgesic drugs. RESULTS: Twenty nine studies met inclusion criteria. None were randomized c ontrolled trials. For one or more falls, the pooled Odds Ratio (95% Confide nce Interval) was 1.08 (1.02-1.16) for diuretic use, 1.06 (0.97-1.16) for t hiazide diuretics, 0.90 (0.73-1.12) for loop diuretics, 0.93 (0.77-1.11) fo r beta-blockers, 1.16 (0.87-1.55) for centrally acting antihypertensives, 1 .20 (0.92-1.58) for ACE inhibitors, 0.94 (0.77-1.14) for calcium channel bl ockers, 1.13 (0.95-1.36) for nitrates, 1.59 (1.02-2.48) for type la antiarr hythmics, and 1.22 (1.05-1.42) for digoxin use. For analgesic drugs, the po oled OR was 0.97 (0.78-1.20) for narcotic use, 1.09 (0.88-1.34) for nonnarc otic analgesic use, 1.16 (0.97-1.38) for NSAID use, and 1.12 (0.80-1.57) fo r aspirin use. There was no statistically significant heterogeneity of pool ed odds ratios. There were no differences between the pooled odds ratios fo r studies with mean subject age <75 versus greater than or equal to 75 year s old or for studies in communities with <35% versus greater than or equal to 35% fallers. Tn studies of the relationship between psychotropic, cardia c, or analgesic drugs and falls, subjects reporting the use of more than th ree or four medications of any type were at increased risk of recurrent fal ls. CONCLUSION: Digoxin, type IA antiarrhythmic, and diuretic use are associate d weakly with falls in older adults. No association was found for the other classes of cardiac or analgesic drugs examined. The evidence to date, howe ver, is based solely on observational data, with minimal adjustment for con founders, dosage, or duration of therapy. Older adults taking more than thr ee or four medications were at increased risk of recurrent falls. As a resu lt of the incidence of falls and their consequences in this population, pro grams designed to decrease medication use should be evaluated for their imp act on fall rates.