title: Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly.
abstract: BACKGROUND
  While central nervous system (CNS) active medications such as psychotropics and narcotic analgesics have been implicated in contributing to falls in older adults, the combined effect of multiple CNS-active medications has not been investigated. The purpose of this study was to examine the influence, in community-dwelling elderly, of (1) taking multiple CNS-active medications on fall liability and (2) individual classes of CNS-active medications (using discrete drug classification) on the risk of falls after controlling for important confounders--age, mobility, cognition and depression.
  
  
  METHODS
  305 community-dwelling male veterans (age: 70-104) were screened at study entry for mobility, cognition and depression. CNS-active medications were categorized as benzodiazepines, other sedative-hypnotics, neuroleptics, tricyclic antidepressants, and opioid analgesics. Subjects were prospectively followed for 6 months to monitor falls; at the end of this time period, subjects were classified as fallers (at least one fall) or nonfallers. The relationship between CNS-active drug use and falls was examined using multivariable analyses.
  
  
  RESULTS
  The risk of falls was significantly greater in CNS-active medication users as compared with nonusers. Adjusted odds ratio for one CNS-active drug was 1.54 (95% confidence interval 1.07-2.22) and for two or more agents 2.37 (95% confidence interval 1.14-4.94).
  
  
  CONCLUSIONS
  In community-dwelling elderly, the use of multiple CNS-active medications is associated with enhanced falls liability, over and above the use of one CNS-active drug alone. This apparent dose-response relationship provides support for causality.
authors.affiliation: Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, N.C., USA. dweiner+@pitt.edu
authors.forename: D K
authors.initials: DK
authors.lastname: Weiner
authors.forename: J T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: S A
authors.initials: SA
authors.lastname: Studenski
mesh_terms: D000058:Accidental Falls; D000368:Aged; D002491:Central Nervous System Agents / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D014728:Veterans
chemical_list: D002491:Central Nervous System Agents