The Effects of Fall-Risk-Increasing Drugs on Postural Control: A Literature Review

Abstract

Meta-analyses showed that psychotropic drugs (antidepressants, neuroleptics, benzodiazepines, antiepileptic drugs) and some cardiac drugs (digoxin, type IA anti-arrhythmics, diuretics) are associated with increased fall risk. Because balance and gait disorders are the most consistent predictors of future falls, falls due to use of these so-called fall-risk-increasing drugs (FRIDs) might be partly caused by impairments of postural control that these drugs can induce. Therefore, the effects of FRIDs on postural control were examined by reviewing literature. Electronic databases and reference lists of identified papers were searched until June 2013. Only controlled research papers examining the effects of FRIDs on postural control were included. FRIDs were defined according to meta-analyses as antidepressants, neuroleptics, benzodiazepines, antiepileptic drugs, digoxin, type IA anti-arrhythmics, and diuretics. Ninety-four papers were included, of which study methods for quantifying postural control, and the effects of FRIDs on postural control were abstracted. Postural control was assessed with a variety of instruments, mainly evaluating aspects of body sway during quiet standing. In general, postural control was impaired, indicated by an increase in parameters quantifying body sway, when using psychotropic FRIDs. The effects were more pronounced when people were of a higher age, used psychotropics at higher daily doses, with longer half-lives, and administered for a longer period. From the present literature review, it can be concluded that psychotropic drugs cause impairments in postural control, which is probably one of the mediating factors for the increased fall risk these FRIDs are associated with. The sedative effects of these drugs on postural control are reversible, as was proven in intervention studies where FRIDs were withdrawn. The findings of the present literature review highlight the importance of using psychotropic drugs in the older population only at the lowest effective dose and for a limited period of time.

Validity and Reliability of Gait and Postural Control Analysis Using the Tri-axial Accelerometer of the iPod Touch

“…These patients are characterized by a combination of physical, mental and social problems, use of polypharmacy and consequently high fall risk. 2,3 An instrument that could quantitatively and objectively evaluate and assess deterioration in balance and gait, and monitor the impact of mobility improving interventions is thus of great importance.…”

A Brazilian-Portuguese version of the Kinesthetic and Visual Motor Imagery Questionnaire

“…The exclusion criteria were: Mini-Mental State Examination (MMSE) scores lower than the cut-offs for literate (24/30) or illiterate adults (20/30; it is estimated that 8.3% of Brazilians older than 15 years are illiterate) 10,11 ; use of drugs affecting cognition or balance such as benzodiazepines, neuroleptics and antiepileptic drugs 12 ; history of other neurological conditions; uncontrolled medical disease; blindness 13 and severe congenital or acquired visual deficits; history of depression and alcohol abuse, evaluated with DSM-V criteria 14 , and other psychiatric conditions such as psychosis or schizophrenia reported by participants and/or their caregivers. Because the study provided groundwork for a project on motor imagery in lower limb recovery, we also excluded participants with a Berg Balance Scale > 54 points, as lower scores are associated with an increased risk of falls (maximum score, 56 points) 15 and the goal of the rehabilitation project was to improve balance and decrease this risk.…”

Cognitively and socially induced stress affects postural control

“…Participants were undergraduate psychology students and received course credit for their participation. They reported no major neurological or musculoskeletal disorders and no intake of medication that affects postural control, for example, sleep medication or antidepressants (de Groot et al 2013). All participants provided written informed consent and the study was approved by the School of Psychology, Queen's University Belfast ethics committee.…”