Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: I. Psychotropic Drugs

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

doi:10.1111/j.1532-5415.1999.tb01898.x

Cited by 1,012 publications

(688 citation statements)

References 77 publications

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“…Como em outros estudos, nossos resultados mostram uma associação entre gênero, idade avançada, ser separado/viúvo, ter baixo nível socioeconômico, a autopercepção de saúde e satisfação com renda, a capacidade em executar as atividades cotidianas como variáveis associadas a um maior risco de quedas e que permitem intervenções preventivas em todos os seus níveis de ação. 7,[12][13][14][15] No estudo de Fabrício et al, 15 54% das quedas apresentaram como causa um ambiente inadequado, sendo identificadas questões como piso escorregadio, objetos jogados no chão, subir em objetos para alcançar algo, trombar com outras pessoas, degrau e queda da cama, o que enfatiza a possibilidade de ações educativas a serem implementadas em uma abordagem preventiva.…”

Section: Discussionunclassified

Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro

Motta

Aguiar

Coutinho

et al. 2010

Rev. bras. geriatr. gerontol.

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INTRODUÇÃO: Estima-se que 50% das quedas em idosos resultem em algum tipo de lesão. O objetivo deste estudo é estimar a prevalência e identificar fatores associados a quedas em idosos em um município no Rio de Janeiro. METODOLOGIA: Um inquérito foi conduzido em residentes com mais de 60 anos capazes de prestar informações por si, através de um questionário de avaliação multidimensional, aplicado por agentes comunitários treinados. As análises incluíram cálculos de proporções e respectivos intervalos de confiança de 95%. RESULTADOS: Foram entrevistados 1.064 idosos, em sua maioria mulheres (57%), com idade média de 71,4 anos. No ano anterior à entrevista, 322 participantes (30,3% - IC95% 27,6-33,2) caíram, dos quais 148 (13,9% - IC95% 11,9-16,2) o fizeram pelo menos duas vezes. Algumas associações se evidenciaram: sexo feminino, idade avançada, ser divorciado, morar só, assim como as variáveis indicadoras de más condições de saúde, capacidade funcional e satisfação com a vida. CONCLUSÃO: Este estudo ratifica fatores associados a quedas em idosos já conhecidos. O grande desafio deste conhecimento é a proposição de intervenções nos fatores modificáveis e a identificação ativa dos idosos sob risco, objetivando a reabilitação preventiva.

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Section: Discussionunclassified

Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro

Motta

Aguiar

Coutinho

et al. 2010

Rev. bras. geriatr. gerontol.

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“…1,2 Use of benzodiazepines has been associated with several negative health consequences, including falls, 3 hip fractures, 4,5 depressed mood, 6 and impaired cognition. 7 Long-term use of benzodiazepines is more common in older than in younger individuals, 8 despite recommendations to avoid prolonged use in older people.…”

Section: Introductionmentioning

confidence: 99%

Is the Use of Benzodiazepines Associated with Incident Disability?

Gray¹,

LaCroix

Blough³

et al. 2002

J American Geriatrics Society

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OBJECTIVES-This study examined the association between benzodiazepine use and incident disability with an emphasis on elucidating whether the underlying health conditions that result in benzodiazepine use (confounding factors) or intrinsic adverse effects of benzodiazepine use were responsible for functional decline. DESIGN-Cohort study with follow-up of 4 to 5 years. SETTING-A health maintenance organization (HMO) in western Washington.PARTICIPANTS-Individuals aged 65 and older from a random sample of HMO enrollees who participated in a health promotion intervention trial (n = 1,519).MEASUREMENTS-Benzodiazepine use was ascertained from computerized pharmacy records. Self-reported functional status was assessed using a six-item physical function scale ranging from vigorous activity to self-care activities of daily living (ADLs). Two outcomes were examined: decline in overall physical function and limitations in self-care ADLs. Multivariate models were examined that included demographic characteristics, health status, and health behaviors that were likely to be confounders. Several analyses were conducted to examine whether benzodiazepine use or confounding factors were responsible for functional decline.Address correspondence to Shelly L. Gray, PharmD, MS, University of Washington, School of Pharmacy, Health Sciences Center H-361D, Box 357630, Seattle, WA 98195. slgray@u.washington.edu. HHS Public AccessAuthor manuscript J Am Geriatr Soc. Author manuscript; available in PMC 2016 March 03. Published in final edited form as:J Am Geriatr Soc. 2002 June ; 50(6): 1012-1018. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript RESULTS-Benzodiazepine use was significantly associated with incident loss of physical function (hazard ratio (HR) = 1.51, 95% confidence interval (CI) = 1.02-2.24) in the fully adjusted model. Although use of benzodiazepines was associated with limitations in ADLs, it was not significant when adjusting for other factors (HR = 1.71, 95% CI = 0.87-3.34). Several of our findings suggest that the health conditions leading to benzodiazepine use may partly or fully explain these associations: (1) use of anxiolytic benzodiazepines (HR = 1.95, 95% CI = 1.24-3.07), but not hypnotic agents (HR = 1.21, 95% CI = 0.73-2.00), was associated with functional decline; (2) adjustment for health status variables minimized these associations; and (3) there was little evidence of dose response.CONCLUSIONS-A modestly increased risk for decline in physical function was associated with benzodiazepine use, especially of anxiolytic agents. The health conditions that result in benzodiazepine use may be more important in the pathogenesis of disability than benzodiazepine use itself. Although there are many reasons for avoiding benzodiazepines in older adults, it is still unclear whether use contributes independently to functional decline. One problem encountered when attempting to examine the effect of benzodiazepine use on functional decline is determining whether it is the drug itself or the med...

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“…27 The use of neurologically active medications and, specifically, antidepressants, irrespective of subgroup, is an established risk factor for falls in older people. 13,28 This study indicates that the use of neurologically active medications, particularly SSRIs and SNRIs, is associated with falls in people with MS. In older adults, the newer SSRIs do not seem to be associated with less fall risk than the older tricyclic antidepressant medications.…”

Section: Number Of Medications Reported and Fallsmentioning

confidence: 99%

“…10,11 Although there are limited interventions available to modify these endogenous fall risk factors, modifiable exogenous factors may also contribute to fall risk in MS. In older people, in whom fall risk is most well understood, the use of multiple medications, 12 particularly psychotropics, has been found to significantly increase fall risk, 13,14 and modifying medication prescription can prevent falls. 15,16 Many patients with MS are prescribed and take multiple medications, including many neurologically active drugs.…”

mentioning

confidence: 99%