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Psychotropic Meds Link Falls to Elderly

Posted by Phillipa on February 24, 2013, at 12:19:54

No wonder lower doses of meds now. Phillipa

Strong Link Between Frequent Falls and Psychotropic Meds

Caroline Cassels
Feb 13, 2013

Psychotropic medications, including short-acting benzodiazepines, have been linked to a significantly increased risk for frequent falls in the elderly and should be avoided in this vulnerable population if possible, new research suggests.

A retrospective study conducted by investigators at the University of Utrecht in The Netherlands found that there was up to a 3.5-fold increased risk for falls across all psychotropic drug classes examined by the investigators, including antipsychotics, hypnotics and anxiolytics, antidepressants, and antidementia medications.

"This study confirms that taking psychotropic medication, including short-acting benzodiazepines, strongly increases the frequency of falls in elderly. This relation should be explicitly recognized by doctors prescribing for older people, and by older people themselves. If possible such medication should be avoided for elderly patients with other risk factors for falling," the authors, led by Astrid M. van Strien, write.

The study was published online January 31 in Maturitas.

According to the authors, falls constitute a leading cause of hospitalization and death among the elderly. Although previous research has shown a link between psychotropic medications and falls in this patient population, the authors note that the contribution of specific psychotropic drugs remains unclear.

To evaluate the link between the use of different classes of psychotropic drugs and the frequency of falls in the elderly, the researchers conducted a retrospective cohort study in 404 elderly patients attending a geriatric outpatient clinic between January 1, 2011, and April 1, 2012.

Frequency of falls in the previous year and medication use were recorded, and logistic regression analysis was performed to assess the relationship between the frequency of falling in the past year and the use of psychotropics.

Of the total cohort of 404 patients, 238 (58.9%) had experienced 1 or more falls in the past year, and 139 (34%) used psychotropic medication. The researchers report that there were no significant differences between users and nonusers of psychotropic medications with respect to age, body mass index, and MiniMental State Examination (MMSE) scores.

Adjusted analysis revealed that frequent falls remained significantly associated with exposure to psychotropic medications (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.17 - 2.38).

For specific classes of drugs, the odds ratios and 95% confidence intervals were as follows:

Antipsychotics: OR, 3.62; 95% CI, 1.27 - 10.33

Hypnotics and anxiolytics: OR, 1.81; 95% CI, 1.05 - 3.11

Short-acting benzodiazepines or Z-drugs: OR, 1.94; 95% CI, 1.10 - 3.42

Antidepressants: OR, 2.35; 95% CI, 1.33 - 4.16

The authors note that incidental falls were not associated with these medications but that frequent falls were.

"This can be explained by the fact that an incidental-accident is more likely to be the underlying cause in patients with a single fall, but not in patients with multiple falls," they write.

The researchers conclude that it is probably useful for physicians to try to lower the use of psychotropic medications in elderly patients where possible. However, they acknowledge that withdrawing these medications can be challenging, owing to patients' propensities for dependence and rebound insomnia. Nevertheless, they note that "despite these challenges, specialist recommendations to cease or reduce dosage of these medications are associated with a high success rate."

The authors have disclosed no relevant financial relationships.

Maturitas. Published online January 31, 2013. Abstract




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