TY - JOUR
T1 - Fall-Risk-Increasing Drugs
T2 - A Systematic Review and Meta-analysis: III. Others
AU - Seppala, Lotta J.
AU - van de Glind, Esther M.M.
AU - Daams, Joost G.
AU - Ploegmakers, Kimberley J.
AU - de Vries, Max
AU - Wermelink, Anne M.A.T.
AU - van der Velde, Nathalie
AU - Blain, Hubert
AU - Bousquet, Jean
AU - Bucht, Gösta
AU - Caballero-Mora, Maria Angeles
AU - van der Cammen, Tischa
AU - Eklund, Patrik
AU - Emmelot-Vonk, Marielle
AU - Gustafson, Yngve
AU - Hartikainen, Sirpa
AU - Kenny, Rose Anne
AU - Laflamme, Lucie
AU - Landi, Francesco
AU - Masud, Tahir
AU - O'Byrne-Maguire, Irene
AU - Petrovic, Mirko
AU - Rodriguez, Leocadio
AU - Seppälä, Lotta
AU - Svensson, Olle
AU - Szczerbińska, Katarzyna
AU - Thaler, Heinrich
AU - van der Velde, Nathalie
N1 - Funding Information:
This work was supported by the Clementine Brigitta Maria Dalderup Fund, which is an Amsterdam University Fund. The sponsor played no part in the design, methods, data collection, analysis and preparation of this paper. There is no conflict of interest in this regard.
Publisher Copyright:
© 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background and objective: The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications. Methods and design: 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 nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately. Results: In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association). Conclusion: Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.
AB - Background and objective: The use of psychotropic medication and cardiovascular medication has been associated with an increased risk of falling. However, other frequently prescribed medication classes are still under debate as potential risk factors for falls in the older population. The aim of this systematic review and meta-analysis is to evaluate the associations between fall risk and nonpsychotropic and noncardiovascular medications. Methods and design: 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 nonpsychotropic and noncardiovascular medications as risk factors for falls in participants ≥60 years or participants with a mean age ≥70 years. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratio (OR) estimates separately. Results: In a qualitative synthesis, 281 studies were included. The results of meta-analysis using adjusted data were as follows (a pooled OR [95% confidence interval]): analgesics, 1.42 (0.91-2.23); nonsteroidal anti-inflammatory drugs (NSAIDs), 1.09 (0.96-1.23); opioids, 1.60 (1.35-1.91); anti-Parkinson drugs, 1.54 (0.99-2.39); antiepileptics, 1.55 (1.25-1.92); and polypharmacy, 1.75 (1.27-2.41). Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and setting in most cases. In a descriptive synthesis, consistent associations with falls were observed for long-term proton pump inhibitor use and opioid initiation. Laxatives showed inconsistent associations with falls (7/20 studies showing a positive association). Conclusion: Opioid and antiepileptic use and polypharmacy were significantly associated with increased risk of falling in the meta-analyses. Long-term use of proton pump inhibitors and opioid initiation might increase the fall risk. Future research is necessary because the causal role of some medication classes as fall-risk-increasing drugs remains unclear, and the existing literature contains significant limitations.
KW - Accidental falls
KW - antiepileptic
KW - medication classification system
KW - opioid
KW - polypharmacy
UR - http://www.scopus.com/inward/record.url?scp=85041347202&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2017.12.099
DO - 10.1016/j.jamda.2017.12.099
M3 - Article
AN - SCOPUS:85041347202
SN - 1525-8610
VL - 19
SP - 372.e1-372.e8
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 4
ER -