Abstract
Background and objective
Use of certain medications is recognized as a major and modifiable risk factor for
falls. Although the literature on psychotropic drugs is compelling, the literature
on cardiovascular drugs as potential fall-risk-increasing drugs is conflicting. The
aim of this systematic review and meta-analysis is to provide a comprehensive overview
of the associations between cardiovascular medications and fall risk in older adults.
Methods
Design: A systematic review and meta-analysis. Data sources: Medline, Embase, and
PsycINFO. Key search concepts were “fall,” “aged,” “causality,” and “medication.”
Studies that investigated cardiovascular medications as risk factors for falls in
participants ≥60 years old or participants with a mean age of 70 or older were included.
A meta-analysis was performed using the generic inverse variance method, pooling unadjusted
and adjusted odds ratios (ORs) separately.
Results
In total, 131 studies were included in the qualitative synthesis. Meta-analysis using
adjusted ORs showed significant results (pooled OR [95% confidence interval]) for
loop diuretics, OR 1.36 (1.17, 1.57), and beta-blocking agents, OR 0.88 (0.80, 0.97).
Meta-analysis using unadjusted ORs showed significant results for digitalis, OR 1.60
(1.08, 2.36); digoxin, OR 2.06 (1.56, 2.74); and statins, OR 0.80 (0.65, 0.98). Most
of the meta-analyses resulted in substantial heterogeneity that mostly did not disappear
after stratification for population and setting. In a descriptive synthesis, consistent
associations were not observed.
Conclusion
Loop diuretics were significantly associated with increased fall risk, whereas beta-blockers
were significantly associated with decreased fall risk. Digitalis and digoxin may
increase the risk of falling, and statins may reduce it. For the majority of cardiovascular
medication groups, outcomes were inconsistent. Furthermore, recent studies indicate
that specific drug properties, such as selectivity of beta-blockers, may affect fall
risk, and drug-disease interaction also may play a role. Thus, studies addressing
these issues are warranted to obtain a better understanding of drug-related falls.
Keywords
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Article info
Publication history
Published online: February 03, 2018
Footnotes
Max de Vries and Lotta J. Seppala are co–first authors.
Conflicts of interest statement: 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.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
