Three classes of drugs – sedatives and hypnotics, antidepressants, and benzodiazepines – substantially raise the risk of falling in the elderly, according to a meta-analysis in the Nov. 23 issue of the Archives of Internal Medicine.
These findings underscore “the need for caution when prescribing these medications to seniors,” said John C. Woolcott of the University of British Columbia, Vancouver, and his associates.
“Falls and fall-related complications are the fifth leading cause of death in the developed world, and more than 30% of persons older than 65 years will fall at least once annually,�� they noted.
In performing their meta-analysis, Mr. Woolcott and his colleagues updated the results of two previous meta-analyses conducted by Dr. Rosanne M. Leipzig and her colleagues that included papers published between 1966 and 1996 (Arch. Intern. Med. 2009;169:1952-60).
Mr. Woolcott and his colleagues conducted a Bayesian meta-analysis incorporating the results of this previous meta-analysis with studies published afterward, between 1996 and 2007.
The 22 studies in this meta-analysis included 10 cohort studies, 5 case-control studies, and 7 cross-sectional studies involving 79,081 subjects aged 60 years or older. None of the 22 studies was a randomized, controlled trial. Falls deemed to be “a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in a stroke, or an epileptic seizure” were excluded.
The use of sedatives and hypnotics, antidepressants, and benzodiazepines was significantly associated with falling. Of those three drug classes, the investigators found that antidepressants had the strongest association with a fall experience, with an updated Bayesian OR of 1.68.
In contrast, the use of six other classes of drugs – neuroleptics and antipsychotics, antihypertensives, diuretics, beta-blockers, narcotics, and nonsteroidal anti-inflammatory drugs – did not significantly raise the risk of falling, the investigators said. Drugs in the narcotics class had an OR point estimate of 0.96, which means narcotics had the lowest association with a fall experience.
These findings were consistent across the studies reviewed, regardless of whether subjects lived in long-term care facilities, they said.
Mr. Woolcott and his colleagues reported that a strength of their meta-analysis is its use of Bayesian methodology, which allowed the investigators to incorporate information from the previous meta-analysis with more recently completed studies. However, they cited the relatively small number of studies meeting their inclusion criteria of using falls as an outcome as a key limitation.
The investigators hope that future research in this area is able to be completed with larger sample sizes in community and long-term care settings, Mr. Woolcott wrote.
The study was funded partly by the Canadian Institutes of Health Research. The investigators reported no financial disclosures.
Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
据11月23日《内科学文献》的meta分析称，3类药物——镇静药、抗抑郁药以及苯二氮类药物——显著增加老年人跌倒的风险。
温哥华不列颠哥伦比亚大学的John C. Woolcott及其同事说，这些发现强调了“在为老年人开具这些药的处方时需要谨慎”。
他们指出，在发达国家，跌倒以及跌倒相关并发症是第5大死亡原因，并且在65岁以上人群中，超过30%的人至少每年跌倒1次。
在进行meta分析的过程中，Woolcott先生及其同事们对Rosanne M. Leipzig及其同事们此前进行过的两个meta分析的结果加以更新，后者纳入了1966~1996年间发表的论文(Arch. Intern. Med. 2009;169:1952-60)。
Woolcott先生及其同事们进行了贝叶斯meta分析，其合并了之前meta分析的结果，后者纳入了1996~2007年间发表的研究。
该meta分析中的22项研究包括了10项队列研究，5项病例对照研究，7项横向研究，共涉及79,081例60岁及以上的受试者。这22项研究中没有随机对照试验。“持续暴力打击、失去知觉、突发瘫痪(如卒中引起的)以及癫痫发作”所致的跌倒被排除在外。
使用镇静药、抗抑郁药以及苯二氮类药与跌倒高度相关。研究者发现在这3类药中抗抑郁药与跌倒的相关程度最高，更新后的贝叶斯 OR值为1.68。
与之对照，其他6类药物——安定药和抗精神病药、抗高血压药、利尿剂、β受体阻滞剂、麻醉药以及非甾体抗炎药——并不显著增加跌倒的风险，研究人员说。麻醉药类的药物OR分值估计为0.96，意味着麻醉药与跌倒的关联程度最低。
他们说，无论受试者是否在长期护理机构生活，这些发现在所有被回顾的研究中是一致的。
Woolcott先生及其同事们报告说其meta分析的优势在于使用了贝叶斯方法，该方法让研究者能够将以往的meta分析结果与更新的完整的研究结合在一起。然而他们所引用的符合以跌倒作为终点的入选标准的研究数量相对较少，这是一个重要局限。
Woolcott先生写道，研究者希望今后能够在社区和长期护理机构中进行该领域的更大样本量的研究。
该研究由加拿大卫生研究院部分资助。研究者称无经济利益冲突披露。
爱思唯尔 版权所有
