Medication-related fall incidents in an older, ambulant population: the B-PROOF study.
BACKGROUND
Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall.


METHODS
Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged ≥65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use.


RESULTS
During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95% CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95% CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95% CI 1.02-1.71]), and antidepressant use (HR 1.40 [95% CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk.


CONCLUSIONS
Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.
Section of Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Annelies C
AC
Ham
Karin M A
KM
Swart
Anke W
AW
Enneman
Suzanne C
SC
van Dijk
Sadaf
S
Oliai Araghi
Janneke P
JP
van Wijngaarden
Nikita L
NL
van der Zwaluw
Elske M
EM
Brouwer-Brolsma
Rosalie A M
RA
Dhonukshe-Rutten
Natasja M
NM
van Schoor
Tischa J M
TJ
van der Cammen
Paul
P
Lips
Lisette C P G M
LC
de Groot
André G
AG
Uitterlinden
Renger F
RF
Witkamp
Bruno H
BH
Stricker
Nathalie
N
van der Velde
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects; D001569:Benzodiazepines / Q000009:adverse effects; D005260:Female; D006299:Health Services for the Aged; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D057187:Independent Living; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
D000889:Anti-Arrhythmia Agents; D001569:Benzodiazepines