title: Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study.
abstract: OBJECTIVE
  Falling in older persons is a frequent and serious clinical problem. Several drugs have been associated with increased fall risk. The objective of this study was to identify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall-risk-increasing drugs as a single intervention in older fallers.
  
  
  METHODS
  In a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall-risk-increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow-up after a set 1 month period of drug withdrawal. Multivariate adjustment for potential confounders was performed with a Cox proportional hazards model.
  
  
  RESULTS
  In 67 patients, we were able to discontinue a fall-risk-increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow-up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow-up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall-risk-increasing drugs, baseline falls frequency, comorbidity, Mini-Mental State Examination score, and reason for referral.
  
  
  CONCLUSIONS
  Withdrawal of fall-risk-increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs.
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Nathalie
authors.initials: N
authors.lastname: van der Velde
authors.forename: Bruno H Ch
authors.initials: BH
authors.lastname: Stricker
authors.forename: Huib A P
authors.initials: HA
authors.lastname: Pols
authors.forename: Tischa J M
authors.initials: TJ
authors.lastname: van der Cammen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors