title: Association between prescribing of cardiovascular and psychotropic medications and hospital admission for falls or fractures.
abstract: OBJECTIVE
  Falls are a major cause of morbidity and mortality in the elderly. This study examined the frequency of hospital admission for falls or fractures, and the association with a recent change in the use of cardiovascular and psychotropic medications.
  
  
  METHODS
  We conducted a retrospective case-cohort study of 39,813 patients aged >65 years from 40 Scottish general practices. Data on current prescriptions, dates of drug changes (defined as increases in dose or starting new drugs), diagnoses and clinical measurements were extracted from primary care electronic records, linked to national hospital admissions data. Multivariable logistic regression was used to model the association of change in prescribing of cardiovascular or psychotropic medication with admission to hospital for falls or fractures in the following 60 days.
  
  
  RESULTS
  A total of 838 patients (2.1 %) were admitted in the 1-year study period. Following adjustment for factors including age, sex, socioeconomic deprivation, co-morbidity and current prescribing, changes in both cardiovascular and psychotropic medications were associated with subsequent admission for falls or fractures (odds ratio [OR] 1.54 [95 % confidence interval (CI) 1.17-2.03] and 1.68 [95 % CI 1.28-2.22], respectively). There was no evidence for a difference in the effect of change in medication for different cardiovascular drug types (p = 0.86), but there was evidence (p = 0.003) for variation in the association between change in different psychotropic medications and admission; the strongest associations were observed for changes in selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 1.99 [95 % CI 1.29-3.08]), non-SSRI/tricyclic antidepressants (OR 4.39 [95 % CI 2.21-8.71]) and combination psychotropic medication (OR 3.05 [95 % CI 1.66-5.63]).
  
  
  CONCLUSIONS
  Recent changes in psychotropic and cardiovascular medications are associated with a substantial increase in risk of hospital admission for falls and fractures. Caution should thus be taken when instigating prescribing changes in relation to these medicines, particularly in individuals already considered to be at high risk, such as those with multiple co-morbidities and the oldest old.
authors: Primary Care Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK. rap55@medschl.cam.ac.uk
authors: Rupert A
authors: RA
authors: Payne
authors: Gary A
authors: GA
authors: Abel
authors: Colin R
authors: CR
authors: Simpson
authors: Simon R J
authors: SR
authors: Maxwell
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology
chemical_list: D011619:Psychotropic Drugs
references: PLoS One. 2008 Jun 18;3(6):e2423
references: 18560599
references: Am J Epidemiol. 1993 Feb 1;137(3):342-54
references: 8452142
references: Drugs Aging. 2011 Nov 1;28(11):895-902
references: 22054230
references: Phys Ther. 2009 Apr;89(4):324-32
references: 19228831
references: Arch Intern Med. 2009 Nov 23;169(21):1952-60
references: 19933955
references: J Trauma. 2011 Sep;71(3):748-53
references: 21045738
references: J Clin Epidemiol. 1998 Mar;51(3):273-83
references: 9495693
references: Health Serv Res. 2006 Apr;41(2):411-28
references: 16584456
references: QJM. 2009 Jul;102(7):477-83
references: 19502289
references: J Gerontol A Biol Sci Med Sci. 2011 Oct;66(10):1124-30
references: 21764842
references: J Epidemiol Community Health. 2003 Sep;57(9):740-4
references: 12933783
references: Age Ageing. 1999 Mar;28(2):121-5
references: 10350407
references: J Gerontol A Biol Sci Med Sci. 2007 Oct;62(10):1172-81
references: 17921433
references: Eur J Clin Pharmacol. 2011 Nov;67(11):1175-88
references: 21584788
references: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006379
references: 19160280