Number and dosage of central nervous system medications on recurrent falls in community elders: the Health, Aging and Body Composition study.
BACKGROUND
Few studies have examined the risk of multiple or high doses of combined central nervous system (CNS) medication use for recurrent falls in the elderly. The study objective was to evaluate whether multiple- or high-dose CNS medication use in older adults was associated with a higher risk of recurrent (>or=2) falls.


METHODS
This longitudinal cohort study included 3,055 participants from the Health, Aging and Body Composition study who were well functioning at baseline. CNS medication use (benzodiazepine and opioid receptor agonists, antipsychotics, antidepressants) was determined annually (except Year 4) during in-person interviews. The number and summated standard daily doses (SDDs; low, medium, and high) of CNS medications were computed. Falls 1 year later were ascertained annually for 5 years.


RESULTS
For a period of 5 years, as many as 24.1% of CNS medication users took 2+ agents annually, whereas as no more than 18.9% of CNS medication users took high doses annually (3+ SDDs). Yearly, as many as 9.7% of participants reported recurrent falls. Multivariable Generalized Estimating Equation analyses showed that multiple CNS medication users compared with never users had an increased risk of sustaining 2+ falls (adjusted odds ratio [OR] 1.95; 95% confidence interval [CI] 1.35-2.81). Those taking high (3+) CNS SDDs also exhibited an increased risk of 2+ falls (adjusted OR 2.89; 95% CI 1.96-4.25).


CONCLUSIONS
Higher total daily doses of CNS medications were associated with recurrent falls. Further studies are needed to determine the impact of reducing the number of CNS medications and/or dosage on recurrent falls.
Hanlon
Joseph T
JT
Department of Medicine, Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. hanlonj@dom.pitt.edu
Boudreau
Robert M
RM
Roumani
Yazan F
YF
Newman
Anne B
AB
Ruby
Christine M
CM
Wright
Rollin M
RM
Hilmer
Sarah N
SN
Shorr
Ronald I
RI
Bauer
Douglas C
DC
Simonsick
Eleanor M
EM
Studenski
Stephanie A
SA
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000375:Aging / Q000187:drug effects* / Q000502:physiology; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001823:Body Composition; D002491:Central Nervous System Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012008:Recurrence; D012111:Residence Characteristics; D018570:Risk Assessment
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002491:Central Nervous System Agents; D001569:Benzodiazepines