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Three drug classes–sedatives and hypnotics, benzodiazepines, and antidepressants–substantially raise the risk of falling in the elderly, according to a meta-analysis in the Archives of Internal Medicine.
The findings underscore “the need for caution when prescribing these medications to seniors,” said John C. Woolcott of the University of British Columbia, Vancouver, and associates. “Falls and fall-related complications are the fifth leading cause of death in the developed world, and more than 30% of persons older than 65 years will fall at least once annually.”
In performing their meta-analysis, Mr. Woolcott and his colleagues updated the results of two previous meta-analyses conducted by Dr. Rosanne M. Leipzig and her colleagues that included papers published between 1966 and 1996 (Arch. Intern. Med. 2009;169:1952-60).
Mr. Woolcott and his colleagues conducted a Bayesian meta-analysis incorporating the results of this previous meta-analysis with studies published afterward, between 1996 and 2007.
The 22 studies in this meta-analysis included 10 cohort studies, 5 case-control studies, and 7 cross-sectional studies involving 79,081 subjects aged 60 years or older. None of the 22 studies was a randomized, controlled trial. Falls deemed to be “a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in a stroke, or an epileptic seizure” were excluded.
The use of sedatives and hypnotics, antidepressants, and benzodiazepines was significantly associated with falling. Of those three drug classes, the investigators found that antidepressants had the strongest association with a fall experience, with an updated Bayesian odds ratio of 1.68.
In contrast, the use of six other classes of drugs–neuroleptics and antipsychotics, antihypertensives, diuretics, beta-blockers, narcotics, and nonsteroidal anti-inflammatory drugs–did not significantly raise the risk of falling, the investigators said. Drugs in the narcotics class had an OR point estimate of 0.96, which means narcotics had the lowest association with a fall experience.
These findings were consistent across the studies reviewed, regardless of whether subjects lived in long-term care facilities, the investigators commented.
Mr. Woolcott and his colleagues reported that a strength of their meta-analysis is its use of Bayesian methodology, which allowed the investigators to incorporate information from the previous meta-analysis with more recently completed studies. However, they cited the relatively small number of studies meeting their inclusion criteria of using falls as an outcome as a key limitation.
The investigators hope that future research in this area is able to be completed with larger sample sizes in community and long-term care settings, Mr. Woolcott wrote.
The study was funded partly by the Canadian Institutes of Health Research. The investigators reported no financial disclosures.
Three drug classes–sedatives and hypnotics, benzodiazepines, and antidepressants–substantially raise the risk of falling in the elderly, according to a meta-analysis in the Archives of Internal Medicine.
The findings underscore “the need for caution when prescribing these medications to seniors,” said John C. Woolcott of the University of British Columbia, Vancouver, and associates. “Falls and fall-related complications are the fifth leading cause of death in the developed world, and more than 30% of persons older than 65 years will fall at least once annually.”
In performing their meta-analysis, Mr. Woolcott and his colleagues updated the results of two previous meta-analyses conducted by Dr. Rosanne M. Leipzig and her colleagues that included papers published between 1966 and 1996 (Arch. Intern. Med. 2009;169:1952-60).
Mr. Woolcott and his colleagues conducted a Bayesian meta-analysis incorporating the results of this previous meta-analysis with studies published afterward, between 1996 and 2007.
The 22 studies in this meta-analysis included 10 cohort studies, 5 case-control studies, and 7 cross-sectional studies involving 79,081 subjects aged 60 years or older. None of the 22 studies was a randomized, controlled trial. Falls deemed to be “a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in a stroke, or an epileptic seizure” were excluded.
The use of sedatives and hypnotics, antidepressants, and benzodiazepines was significantly associated with falling. Of those three drug classes, the investigators found that antidepressants had the strongest association with a fall experience, with an updated Bayesian odds ratio of 1.68.
In contrast, the use of six other classes of drugs–neuroleptics and antipsychotics, antihypertensives, diuretics, beta-blockers, narcotics, and nonsteroidal anti-inflammatory drugs–did not significantly raise the risk of falling, the investigators said. Drugs in the narcotics class had an OR point estimate of 0.96, which means narcotics had the lowest association with a fall experience.
These findings were consistent across the studies reviewed, regardless of whether subjects lived in long-term care facilities, the investigators commented.
Mr. Woolcott and his colleagues reported that a strength of their meta-analysis is its use of Bayesian methodology, which allowed the investigators to incorporate information from the previous meta-analysis with more recently completed studies. However, they cited the relatively small number of studies meeting their inclusion criteria of using falls as an outcome as a key limitation.
The investigators hope that future research in this area is able to be completed with larger sample sizes in community and long-term care settings, Mr. Woolcott wrote.
The study was funded partly by the Canadian Institutes of Health Research. The investigators reported no financial disclosures.
Three drug classes–sedatives and hypnotics, benzodiazepines, and antidepressants–substantially raise the risk of falling in the elderly, according to a meta-analysis in the Archives of Internal Medicine.
The findings underscore “the need for caution when prescribing these medications to seniors,” said John C. Woolcott of the University of British Columbia, Vancouver, and associates. “Falls and fall-related complications are the fifth leading cause of death in the developed world, and more than 30% of persons older than 65 years will fall at least once annually.”
In performing their meta-analysis, Mr. Woolcott and his colleagues updated the results of two previous meta-analyses conducted by Dr. Rosanne M. Leipzig and her colleagues that included papers published between 1966 and 1996 (Arch. Intern. Med. 2009;169:1952-60).
Mr. Woolcott and his colleagues conducted a Bayesian meta-analysis incorporating the results of this previous meta-analysis with studies published afterward, between 1996 and 2007.
The 22 studies in this meta-analysis included 10 cohort studies, 5 case-control studies, and 7 cross-sectional studies involving 79,081 subjects aged 60 years or older. None of the 22 studies was a randomized, controlled trial. Falls deemed to be “a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in a stroke, or an epileptic seizure” were excluded.
The use of sedatives and hypnotics, antidepressants, and benzodiazepines was significantly associated with falling. Of those three drug classes, the investigators found that antidepressants had the strongest association with a fall experience, with an updated Bayesian odds ratio of 1.68.
In contrast, the use of six other classes of drugs–neuroleptics and antipsychotics, antihypertensives, diuretics, beta-blockers, narcotics, and nonsteroidal anti-inflammatory drugs–did not significantly raise the risk of falling, the investigators said. Drugs in the narcotics class had an OR point estimate of 0.96, which means narcotics had the lowest association with a fall experience.
These findings were consistent across the studies reviewed, regardless of whether subjects lived in long-term care facilities, the investigators commented.
Mr. Woolcott and his colleagues reported that a strength of their meta-analysis is its use of Bayesian methodology, which allowed the investigators to incorporate information from the previous meta-analysis with more recently completed studies. However, they cited the relatively small number of studies meeting their inclusion criteria of using falls as an outcome as a key limitation.
The investigators hope that future research in this area is able to be completed with larger sample sizes in community and long-term care settings, Mr. Woolcott wrote.
The study was funded partly by the Canadian Institutes of Health Research. The investigators reported no financial disclosures.