Association Between Medications Acting on the Central Nervous System and Fall-Related Injuries in Community-Dwelling Older Adults: A New User Cohort Study

Abstract

Background It is well established that individual medications that affect the central nervous system (CNS) increase falls risk in older adults. However, less is known about risks associated with taking multiple CNS-active medications. Methods Employing a new user design, we used data from the Adult Changes in Thought study, a prospective cohort of community-dwelling people aged 65 and older without dementia. We created a time-varying composite measure of CNS-active medication exposure from electronic pharmacy fill data and categorized into mutually exclusive categories: current (within prior 30 days), recent (31–90 days), past (91–365 days), or nonuse (no exposure in prior year). We calculated standardized daily dose and identified new initiation. Cox proportional hazards models examined the associations between exposures and the outcome of fall-related injury identified from health plan electronic databases. Results Two thousand five hundred ninety-five people had 624 fall-related injuries over 15,531 person-years of follow-up. Relative to nonuse, fall-related injury risk was significantly greater for current use of CNS-active medication (hazard ratio [HR] = 1.95; 95% CI = 1.57–2.42), but not for recent or past use. Among current users, increased risk was noted with all doses. Risk was increased for new initiation compared with no current use (HR = 2.81; 95% CI = 2.09–3.78). Post hoc analyses revealed that risk was especially elevated with new initiation of opioids. Conclusions We found that current use, especially new initiation, of CNS-active medications was associated with fall-related injury in community-dwelling older adults. Increased risk was noted with all dose categories. Risk was particularly increased with new initiation of opioids.

Prevalence of Central Nervous System–Active Polypharmacy Among Older Adults With Dementia in the US

“…Second, several antipsychotics and citalopram cause QTinterval prolongation, which increases the risk for cardiac arrhythmia. 11,34 Third, fall-related injury is associated with many CNS-active medications, both individually and in combination, 21,35,36 and this increased fall risk associated with CNS-active polypharmacy is the reason it was added to the Beers Criteria as potentially inappropriate. 37 Fourth, many of these medications adversely affect cognition, an undesired side effect in those who have received a dementia diagnosis, a diagnosis applied in clinical practice to patients who have experienced significant declines in cognition and function.…”

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…The prevalence of suspected medication-related falls is about 41% [ 555 ] to 49% [ 556 ]. Increased risk of falls was documented in users of anxiolytics/hypnotics, opioids, sedatives, antihypertensives (especially alpha-blockers), antidepressants, antiparkinsonian medications, antiepileptics and antiarrhythmics [ 557 , 558 , 559 , 560 , 561 , 562 , 563 , 564 , 565 , 566 , 567 , 568 , 569 , 570 , 571 , 572 , 573 , 574 , 575 , 576 , 577 , 578 , 579 , 580 , 581 , 582 , 583 ]; polypharmacy is strongly associated with injurious falls and fractures [ 574 , 582 , 584 , 585 , 586 , 587 , 588 ].…”

Change in central nervous system‐active medication use following fall‐related injury in older adults

“…Health characteristics gathered from the ACT study visit most proximal to index date were self‐rated health (fair/poor vs. good/very good/excellent), osteoarthritis, coronary artery disease (myocardial infarction, angina, coronary artery bypass graft, or angioplasty), prior stroke, frailty (performance‐based gait speed <0.6 m/s or inability to complete the timed walk), and cognition (i.e., CASI score). Treatment for hypertension and treatment for diabetes were ascertained via ≥2 prescription fills from computerized pharmacy data for disease‐related medications (antihypertensive medications; insulin or oral hypoglycemics) within 2 years before index 13,36 . We used ICD‐9 codes to define anxiety, insomnia/sleep problems, Parkinson's disease, urinary incontinence, and depression within 2 years before index (Table S3).…”

“…Treatment for hypertension and treatment for diabetes were ascertained via ≥2 prescription fills from computerized pharmacy data for disease-related medications (antihypertensive medications; insulin or oral hypoglycemics) within 2 years before index. 13,36 We used ICD-9 codes to define anxiety, insomnia/sleep problems, Parkinson's disease, urinary incontinence, and depression within 2 years before index (Table S3). We also recorded prior fall-related injury (measured in the 1-2 years before index).…”