Abstract
Background and objective
Falls are a major public health problem in older adults. Earlier studies showed that
psychotropic medication use increases the risk of falls. The aim of this study is
to update the current knowledge by providing a comprehensive systematic review and
meta-analysis on psychotropic medication use and falls in older adults.
Methods and design
This study is 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 psychotropics (antipsychotics,
antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls
in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses
were performed using generic inverse variance method pooling unadjusted and adjusted
odds ratio (OR) estimates separately.
Results
In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses
using adjusted data showed the following pooled ORs: antipsychotics 1.54 [95% confidence
interval (CI) 1.28–1.85], antidepressants 1.57 (95% Cl 1.43–1.74), tricyclic antidepressants
1.41 (95% CI 1.07–1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85–2.20),
benzodiazepines 1.42 (95%, CI 1.22–1.65), long-acting benzodiazepines 1.81 (95%, CI
1.05–3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04–1.56) Most of the
meta-analyses resulted in substantial heterogeneity that did not disappear after stratification
for population and healthcare setting.
Conclusions
Antipsychotics, antidepressants, and benzodiazepines are consistently associated with
a higher risk of falls. It is unclear whether specific subgroups such as short-acting
benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of
fall risk. Prescription bias could not be accounted for. Future studies need to address
pharmacologic subgroups as fall risk may differ depending on specific medication properties.
Precise and uniform classification of target medication (Anatomical Therapeutic Chemical
Classification) is essential for valid comparisons between studies.
Keywords
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Article info
Publication history
Published online: February 02, 2018
Footnotes
This work was supported by the Clementine Brigitta Maria Dalderup fund, Amsterdam University fund. The sponsor played no part in the design, methods, data collection, analysis and preparation of this paper.
The authors declare no conflicts of interest.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
