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Psychotropic Medications and Risk for Falls Among Community-Dwelling Frail Older People: An Observational Study

¹ Department of Gerontology-Geriatrics, Catholic University of Sacred Heart, Rome, Italy.
² Sticht Center on Aging, Wake Forest University-Baptist Medical Center, Winston Salem, North Carolina.

Address correspondence to Dr. Francesco Landi, Istituto di Medicina Interna e Geriatria, Centro Medicina dell'Invecchiamento (C.E.M.I.), Universitá Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy. E-mail: francesco_landi{at}rm.unicatt.it

Background. Injuries due to falls are one of the most important public health concerns for all ages, but especially for frail elderly people. Although a small number of falls have a single cause, the majority have many different causes resulting from the interactions between intrinsic or extrinsic risk factors.

Methods. We conducted an observational study on data from a large population of community-dwelling elderly people to tests the hypothesis that the current use of different classes of psychotropic medications, including antipsychotic agents, benzodiazepines, nonbenzodiazepine sedative-hypnotics, and antidepressants, increases the risk for falls. We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs (n = 2854).

Results. After adjusting for all potential confounders, users of any psychotropic drugs had an increased risk of fall of nearly 47% (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.24–1.74). Similarly, compared with nonusers, users of atypical antipsychotic drugs also had an increased risk of falling at least once (OR, 1.45; 95% CI, 1.00–2.11). Among benzodiazepine users, patients taking agents with long elimination half-life (OR, 1.45; 95% CI, 1.00–2.19) and patients taking benzodiazepines with short elimination half-life (OR, 1.32; 95% CI, 1.02–1.72) had an increased risk of falls. Patients taking antidepressants did not show a higher risk of falling compared to nonusers (OR, 0.92; 95% CI, 0.83–1.41).

Conclusions. Our data suggest that, among psychotropic medications, antipsychotic agents and benzodiazepines are associated with an increased risk of falls. Our findings do not support the hypothesis that preferential prescribing of short-acting benzodiazepines instead of long-acting agents or atypical antipsychotic medications instead of typical agents will substantially decrease fall risk associated with the use of these classes of drugs.

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