Psychoactive medication use, sensori‐motor function and falls in older women.

Lord, Stephen R.; Anstey, Kaarin J.; Williams, Philippa; Ward, John A.

doi:10.1111/j.1365-2125.1995.tb04441.x

Cited by 76 publications

(49 citation statements)

References 23 publications

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“…In our study, however, despite significantly reducing the proportion of residents with postural hypotension, there was no corresponding reduction in falls, suggesting that postural hypotension alone is not a key risk factor for falls in this population. A study of psychoactive medication use and falls in elderly people also reported a lack of association between postural hypotension and falls [15]. Our project is one of the few trials that have attempted to examine the effectiveness of a fall prevention approach amongst those in institutional care [16].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples’ Homes

McMurdo

Millar

Daly³

2000

Gerontology

151

105

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Background: Falls are a major cause of morbidity in old age. A small number of fall prevention trials in cognitively intact community-dwelling older people have been effective. This study set out to examine the preventability of falls in older people living in institutional care. Objective: To evaluate the effectiveness of falls risk factor assessment/modification and seated balance exercise training in reducing falls among elderly people living in residential care. Methods: 133 residents with a mean age of 84± (SD) 6.8 years were allocated at random by home to receive either a 6-month falls risk factor assessment/modification and seated balance exercise training programme (n = 77) or 6 months of reminiscence therapy (n = 56). The risk factors targeted were postural hypotension, polypharmacy, visual acuity, and ambient lighting levels. Falls risk factor assessments and recommendation for modifications were performed at baseline in the intervention group and assessments repeated at 6 months. Functional reach, reaction time, timed up-and- go, grip strength, spinal flexibility, and Philadelphia Geriatric Centre Morale Scale and Mini-Mental State Examination scores were determined at baseline and at 6 months by a ‘blind’ observer. Falls and fractures were then monitored in both groups during a 7- to 12-month falls-monitoring follow-up period. Results: Only 90 of 133 (67.7%) residents completed the 6-month intervention period, and 84 (63.2%) completed the 7- to 12-month falls-monitoring follow-up period. Both prevalence of postural hypotension (p = 0.0005) and poor visual acuity (p = 0.04) were reduced in the intervention group. There was no difference between the groups in the number of falls sustained, the risk of falling [odds ratio 0.45 (95% CI 0.19–1.14)], or in the risk of recurrent falling [odds ratio 1.07 (95% CI 0.40–2.97)]. No significant differences were found between the groups with regard to change in other outcome measures. Conclusions: The high drop-out rate reduced the power of this study to detect any effect of the interventions used. It is possible that either the exercises were not sufficiently vigorous or that to improve balance exercises must be performed standing. Further research is required to identify effective fall prevention strategies for elderly people in residential settings.

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Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples’ Homes

McMurdo

Millar

Daly³

2000

Gerontology

151

105

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“…25 However, prospective studies examining this relationship are small, of short duration, and inconsistent with some showing OH to be associated with risk of falls [26][27][28][29][30] and others showing no association. [31][32][33][34][35][36][37][38] One of the larger prospective studies, conducted in 844 nursing home residents, reported that OH was associated with a higher risk of falls (relative risk: 2.1, 95% CI: 1.4, 3.1) during 1.2 years of follow-up. 26 In contrast, a larger prospective study of 1,517 ambulatory Chinese patients, showed that OH was not associated with falls after adjustment for other risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…At the very least, adults identified as having OH should receive special consideration when prescribed medications known to worsen alertness, affect balance, or increase the risk of falls. 34,37,39 Moreover, interventions useful in preventing falls may be worth implementing in adults with OH such as physical therapy. 46 This study has a number of important limitations.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension in Middle-Age and Risk of Falls

Juraschek

Daya

Appel

et al. 2016

AJHYPE

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Falls are a major cause of morbidity and mortality among older adults. 1,2 Nearly, one-third of persons aged 65 or older falls each year and the rate of falls in the United States is rising. 1,2 Moreover, falls are a significant reason for emergency room visits 3 and predispose to the risk of fracture, 4 posing a substantial burden on the US health system, estimated at approximately $23 billion yearly. 5 Given the aging US population, identifying risk factors for falls and tailoring interventions (e.g., physical therapy, prescription medication choices, or environment-based interventions like handrails) to prevent falls are recognized public health priorities.Orthostatic hypotension (OH) is a controversial risk factor for falls that has important implications for clinical guidelines on blood pressure management. The recently published SPRINT trial suggested that more intensive blood pressure management was associated with a lower risk of OH, but not a decreased risk of injurious falls. 6 OH has been traditionally thought to disproportionately impact older adults. The prevalence of OH increases with age, 7 reaching as high as 20% in adults age 75 years and older. 8 Furthermore, OH is associated with a history of falls as well as greater morbidity from falls in older adults. [8][9][10] Despite the focus in the literature on older adults, OH is also quite prevalent among middle-aged adults (as high as 15.9% in 1 study 11 ), who have a notably lower fall rate. While in the short-term, middle-aged OH may not be a major contributor to risk of serious falls, it is unknown whether it might be associated with risk of falls over time as people age.Thus, the aims of this prospective study were to: (i) determine whether OH in middle age was associated with risk of falls over the lifespan; (ii) characterize the continuous relationship between postural changes in systolic blood pressure (SBP) or diastolic blood pressure (DBP) and fall risk; and (iii) identify whether participant demographic characteristics or cardiovascular risk factors (obesity, hypertension, or diabetes) modified the association between OH and falls. We hypothesized that OH would be significantly associated with falls and this association would be more pronounced among older persons with cardiovascular risk factors. Orthostatic Hypotension in BACKGROUNDOne-third of older adults fall each year. Orthostatic hypotension (OH) has been hypothesized as an important risk factor for falls, but findings from prior studies have been inconsistent.

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“…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.…”

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confidence: 99%