Older adults who take several types of psychotropic medications, such as antidepressants or sedatives, appear more likely to experience falls, according to an analysis of previous studies reported in the November 23 issue of Archives of Internal Medicine.
More than 30 percent of individuals older than 65 will fall at least once a year, and falls and their complications are the fifth-leading cause of death in the developed world. Each year, 85 percent of all injury-related hospital admissions and more than 40 percent of nursing home admissions are related to falls, and the annual costs related to falls and their complications are estimated to be in the billions of dollars worldwide. Both internal and external risk factors contribute to falls, and medications have previously been implicated in the probability of falling and in the risk of sustaining a fracture.

John C. Woolcott, M.A., of University of British Columbia and Centre for Health Evaluation and Outcomes Sciences in Vancouver, and colleagues conducted a meta-analysis of 22 previously published studies conducted between 1996 and 2007. The studies involved 79,081 participants older than age 60 and evaluated nine drug classes: antihypertensive agents for high blood pressure, diuretics, beta-blockers, sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines (the group of drugs that includes Xanax, Librium, Valium, Ativan and Rohypnol), narcotics and nonsteroidal anti-inflammatory drugs (NSAIDs).

When the data were pooled and results adjusted for other factors, the use of sedatives and hypnotics, antidepressants and benzodiazepines were significantly associated with the risk of falling in older adults.

"Given the divergent results shown by some observational assessments within specific medication classes, the results of our meta-analysis reiterate the need for caution when prescribing these medications to seniors," the authors write. "It is hoped that future research in this area can be completed with larger sample sizes in both community and long-term care facility settings and thus improve the quality of information about fall risks that is available to physicians and pharmacists when they are deciding which types of pharmacotherapy to provide."

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