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
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.