Falls are a major cause of morbidity in older people. Although in most cases falls are multifactorial in aetiology, medications are one of the most easily reversible risk factors that need to be considered in the falls assessment process. There is strong evidence that sedatives, particularly benzodiazepines (shortacting and long-acting), are associated with falls with odds ratios in the range of 1.3 to 1.5. Although antipsychotics (typical and atypical) are associated with a similar falls risk, most of the data are from nursing home studies. Antidepressants consistently increase falls risk, with a similar risk from the selective serotonin reuptake inhibitors compared to tricyclic antidepressants. The evidence for an association with falls risk and anticonvulsants, narcotic analgesics, and cardiovascular medications is less strong due to fewer studies published on these drug classes. Medication review is an integral component of the comprehensive falls assessment process in older people. J Pharm Pract Res 2008; 38: 148-51.
INTRODUCTIONFalls are a major cause of morbidity in older people. Thirty per cent of people over the age of 65 years who live in the community fall each year, and frail and institutionalised older people experience a higher percentage of falls. 1 Falls result in hospitalisation due to injury and fracture, as well as other less apparent sequelae, such as the post-fall syndrome of immobility, anxiety and depression.Before reviewing the association between medications and falls, two important points need to be made:• falls are usually multifactorial in aetiology, and only occasionally a single intervention can reduce falls rates significantly; and • data on the relationship between medications and falls are almost entirely derived from observational studies, which have their inherent limitations and biases. Only one double-blind, randomised controlled trial has been published looking at psychotropic medications and falls. However, medication review is an integral component of the comprehensive falls risk assessment of patients and is a recommendation in the consensus guidelines for the prevention of falls in the elderly. 2 Medications are also one of the simplest and most easily reversible risk factors in the falls assessment process.
Background
Literature suggests that preclinical Alzheimer’s disease (AD) is associated with increased falls risk1. Falls are a major cause of morbidity and mortality in older people, particularly people living with dementia. We aimed to identify factors associated with falls in older Australians with baseline Aβ PET imaging.
Method
Participants from the Australian Imaging, Biomarker and Lifestyle Study of Ageing (AIBL), with baseline 11C‐PiB PET and 18‐monthly review for 6 years, including self‐reported falls. Participants with severe illness, alcohol abuse and cerebrovascular disease were excluded. Multivariable logistic regression was used to identify factors associated with falls, including Aβ PET status (elevated/not elevated as previously published).
Result
293 participants (mean age 72.6 years, 52% female, 62% cognitively‐normal, 20% Mild Cognitive Impairment, 18% AD) reported 50 falls during the study period. Female gender (adjusted odds ratio [aOR] 3.17, 95% CI 1.53‐6.58, p=0.002), impaired vision (aOR 2.32, 95% CI 1.08‐4.99, p=0.031) and an education greater than 12 years (aOR 2.40, 95% CI 1.20‐4.82, p=0.014) were associated with incident falls. Age (p=0.172), elevated Aβ (p=0.549) and cognitive status (p=0.799) were not associated with falls.
Conclusion
While our findings that female gender and visual impairment are associated with increased risk of falls are consistent with prior reports, the association with higher education is intriguing and warrants further investigation. Recruitment methods and reporting biases may contribute to the lack of observed association between falls and Aβ or cognitive diagnosis compared with other studies. Future analyses should also include cerebrovascular disease, physical activity, medications and alcohol intake. 1 Stark SL et al. Preclinical Alzheimer disease and risk of falls. Neurology. 2013 Jul 30; 81(5): 437–443.
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