Meta-analysis of the impact of 9 medication classes on falls in elderly persons

Woolcott, John C., Richardson, Kathryn J., Wiens, Matthew O., Patel, Bhavini, Marin, Judith, Khan, Karim M. and Marra, Carlo A. (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of Internal Medicine, 169 21: 1952-1960. doi:10.1001/archinternmed.2009.510

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Author Woolcott, John C.
Richardson, Kathryn J.
Wiens, Matthew O.
Patel, Bhavini
Marin, Judith
Khan, Karim M.
Marra, Carlo A.
Title Meta-analysis of the impact of 9 medication classes on falls in elderly persons
Journal name Archives of Internal Medicine   Check publisher's open access policy
ISSN 0003-9926
1538-3679
Publication date 2009-11-23
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1001/archinternmed.2009.510
Open Access Status File (Publisher version)
Volume 169
Issue 21
Start page 1952
End page 1960
Total pages 9
Place of publication Chicago, IL, United States
Publisher American Medical Association
Language eng
Formatted abstract
Background 
There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis.

Methods 
Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs)

Results 
Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); β-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for β-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment.

Conclusion 
The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.
Keyword Nursing-home residents
Risk-factors
Older-people
Care facilities
Drug-use
Data Set
Community
Women
Predictors
Prevention
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Human Movement and Nutrition Sciences Publications
 
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Created: Fri, 24 Sep 2010, 23:51:23 EST by Jon Swabey on behalf of Faculty Of Health Sciences