Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: II. Cardiac and Analgesic Drugs

Leipzig, Rosanne M.; Cumming, Robert G.; Tinetti, Mary E.

doi:10.1111/j.1532-5415.1999.tb01899.x

Cited by 555 publications

(347 citation statements)

References 68 publications

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“…Embora associação referida por esses autores tenha perdido significância estatística após o controle por múltiplas variáveis de confusão, eles observaram uma relação positiva entre a dose e o risco de múltiplas quedas. Leipzig et al (1999b) não observaram associação entre quedas e o uso desses medicamentos em sua meta-análise.…”

Section: Discussionunclassified

“…Há referência à redução desse risco (LaCroix et al, 1990;Ray et al, 1989), ao aumento (Cumming et al, 1991;Prudham & Evans, 1981) ou ausência de associação (Leipzig et al, 1999b). O possível efeito protetor dos diuréticos tiazídicos tem sido atribuído a uma redução na excreção urinária de cálcio, com conseqüente aumento da densidade ós-sea.…”

Section: Discussionunclassified

“…Leipzig et al (1999aLeipzig et al ( , 1999b realizaram uma meta-análise com estudos que investigaram o papel de medicamentos psiquiátricos, cardiológicos e analgésicos sobre o risco de quedas entre idosos. De acordo com esse estudo, benzodiazepínicos, neurolépticos, sedativos/hipnóticos, antidepressivos, diuréticos em geral, antiarrítimicos e digoxina associaram-se ao maior risco de quedas na população acima de 60 anos.…”

Section: Introductionunclassified

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Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos

Coutinho

Silva

2002

Cad. Saúde Pública

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Quedas seguidas de fraturas entre idosos constituem um importante problema de saúde pública. Um estudo caso-controle foi conduzido para avaliar o papel do uso de um conjunto de medicamentos, como fator de risco para esses acidentes entre pessoas com 60 anos ou mais, na cidade do Rio de Janeiro, Brasil. Cento e sessenta e nove casos de internação por fratura conseqüente a queda, e 315 controles hospitalares foram pareados por idade, sexo e hospital. Odds ratios (OR), ajustados por fatores potenciais de confusão, foram obtidos utilizando-se regressão logística condicional. Observou-se um aumento no risco desses acidentes para o uso de drogas bloqueadoras dos canais de cálcio (OR = 1,96, 1,16-3,30) e benzodiazepínicos (OR = 2,09, 1,08-4,05), e uma redução para o uso de diuréticos (OR = 0,40, 0,20-0,80). Antiácidos, digitálicos e laxantes mostraram-se associados a uma redução do risco de fraturas por quedas, cuja significância estatística atingiu níveis limítrofes (0,05 < p < 0,10). Os dados deste estudo apontam para a necessidade de ponderar os riscos e benefícios no uso de medicamentos em idosos, e orientar tais indivíduos e seus familiares para evitar esses acidentes quando o uso desses medicamentos é necessário.

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Section: Discussionunclassified

Section: Introductionunclassified

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Uso de medicamentos como fator de risco para fratura grave decorrente de queda em idosos

Coutinho

Silva

2002

Cad. Saúde Pública

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“…6 There were similar findings in the meta-analysis by Leipzig et al as well as a non-significant increased odds ratio for non-steroidal antiinflammatory drug use of 1.16, all probably due to the limited powering of the studies due to small numbers of users. 3 …”

Section: Narcotic Analgesicsmentioning

confidence: 99%

“…the more medications used by a patient, regardless of the class of medication, the greater the risk of falling. [3][4][5] In a large Dutch study of community-dwelling elderly, use of four or more medications was associated with an odds ratio of 1.3 (95%CI 1.0-1.7) for having a fall. 4 Other studies have shown that using two or more psychotropic medications in combination is associated with an increased risk of falls compared to the use of a single psychotropic medication.…”

Section: Introductionmentioning

confidence: 99%

Medications and Falls in Older People

Zeimer

2008

Pharmacy Practice and Res

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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.

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