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Epidemiology of Medication-Related Falls and Fractures in the Elderly

  • Review Article
  • Epidemiology
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Summary

About 30% of people aged over 65 years living in the community fall at least once a year; the fall rate is even higher in nursing homes. Many of these falls lead to fractures, the most serious type being hip fractures.

Whether or not the use of various medications causes falls and fractures has been the subject of more than 50 observational epidemiological studies, most published after 1988. Few of these studies were specifically designed to investigate the associations between medication use and falls, so most have methodological limitations. Uncontrolled confounding factors are a particular problem. It is important to recognise these flaws in study design when reviewing the scientific literature on the link between medications and falls and fractures.

Patients taking psychotropic medications appear to have about a 2-fold increased risk of falls and fractures, compared with individuals not taking these drugs. The strongest evidence is for antidepressants; nearly every relevant study has found an association with falls. The relative effect of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors and tricyclic antidepressants on falls is still unknown. The effect on the risk of falling of short-acting versus long-acting benzodiazepines is not straightforward: it may be the benzodiazepine dosage that matters, rather than the drug half-life.

Whether or not any medications used to treat cardiovascular problems cause falls remains unclear. Current evidence suggests that diuretics, in general, do not cause falls and that thiazide diuretics, in particular, may help prevent fractures by slowing the development of osteoporosis. Some studies have found that use of nonsteroidal anti-inflammatory drugs is associated with falling; this deserves further study.

Reducing the use of psychotropic drugs by residents of nursing homes should be a high priority for physicians, pharmacists and nursing staff. Psychotropic drug use should also be kept to a minimum among older people living in the community.

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References

  1. Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med 1989; 320: 1055–9

    Article  PubMed  CAS  Google Scholar 

  2. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–7

    Article  PubMed  CAS  Google Scholar 

  3. Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44: M112–7

    PubMed  CAS  Google Scholar 

  4. Campbell AJ, Borrie MJ, Spears GF, et al. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 1990; 19: 136–41

    Article  PubMed  CAS  Google Scholar 

  5. Cummings SR, Kelsey JL, Nevitt MC, et al. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985; 7: 178–208

    PubMed  CAS  Google Scholar 

  6. Katelaris AG, Cumming RG. Health status before and mortality after hip fracture. Am J Public Health 1996; 86: 557–60

    Article  PubMed  CAS  Google Scholar 

  7. Cumming RG, Klineberg R, Katelaris A. Cohort study of institutionalisation after hip fracture. Aust N Z J Public Health 1996; 20: 579–82

    Article  PubMed  CAS  Google Scholar 

  8. Marottoli RA, Berkman LF, Cooney LM. Decline in physical function following hip fracture. J Am Geriatr Soc 1992; 40: 861–6

    PubMed  CAS  Google Scholar 

  9. Seeley DG, Browner WS, Nevitt MC, et al. Which fractures are associated with low appendicular bone mass in elderly women? Ann Intern Med 1991; 115: 837–42

    PubMed  CAS  Google Scholar 

  10. Nevitt MC, Cummings SR, Kidd S, et al. Risk factors for recurrent nonsyncopal falls: aprospective study. JAMA 1989; 261: 2663–8

    Article  PubMed  CAS  Google Scholar 

  11. Lord SR, Clark RD, Webster IW. Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 1991; 39: 1194–200

    PubMed  CAS  Google Scholar 

  12. Morris JC, Rubin EH, Morris EJ, et al. Senile dementia of the Alzheimer’s type: an important risk factor for serious falls. J Gerontol 1987; 42: 412–7

    PubMed  CAS  Google Scholar 

  13. Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT trials. JAMA 1995; 273: 1341–7

    Article  PubMed  CAS  Google Scholar 

  14. Wolf SL, Barnhart HX, Kutner NG, et al. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J Am Geriatr Soc 1996; 44: 489–97

    PubMed  CAS  Google Scholar 

  15. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl JMed 1995; 332: 767–73

    Article  CAS  Google Scholar 

  16. Dargent-Molina P, Favia F, Grandjean H, et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996; 348: 145–9

    Article  PubMed  CAS  Google Scholar 

  17. Cumming RG, Nevitt MC, Cummings SR. Epidemiology of hip fractures. Epidemiol Rev. In press

  18. Cooper GS, Umbach DM. Are vitamin D receptor polymorphisms associated with bone mineral density? A meta-analysis. J Bone Miner Res 1996; 11: 1841–9

    Article  PubMed  CAS  Google Scholar 

  19. Curb JD, Applegate WB, Vogt TM, et al. Antihypertensive therapy and falls and fractures in the Systolic Hypertension in the Elderly Program [abstract]. J Am Geriatr Soc 1993; 41 Suppl.: SA15

    Google Scholar 

  20. Kelsey JL, Thompson WD, Evans AS. Methods in observational epidemiology. New York: Oxford University Press, 1986: 8–12

    Google Scholar 

  21. Prudham D, Evans JG. Factors associated with falls in the elderly: a community study. Age Ageing 1981; 10: 141–6

    Article  PubMed  CAS  Google Scholar 

  22. Perry BC. Falls among the elderly living in high-risk apartments. J Fam Pract 1982; 14: 1069–73

    PubMed  CAS  Google Scholar 

  23. Blake AJ, Morgan K, Bendall MJ, et al. Falls by elderly people at home: prevalence and associated factors. Age Ageing 1988; 17: 365–72

    Article  PubMed  CAS  Google Scholar 

  24. Wickham C, Cooper C, Margetts BM, et al. Muscle strength, activity, housing and the risk of falls in elderly people. Age Ageing 1989; 18: 47–51

    Article  PubMed  CAS  Google Scholar 

  25. Cumming RG, Miller JP, Kelsey JL, et al. Medications and multiple falls in elderly people: the St Louis OASIS study. Age Ageing 1991; 20: 455–61

    Article  PubMed  CAS  Google Scholar 

  26. Hale WA, Delancy MJ, McGaghie WC. Characteristics and predictors of falls in elderly patients. J Fam Pract 1992; 34: 577–81

    PubMed  CAS  Google Scholar 

  27. Svensson ML, Rundgren A, Landahl S. Falls in 84- to 85-year-old people living at home. Accid Anal Prev 1992; 24: 527–37

    Article  PubMed  CAS  Google Scholar 

  28. O’Loughlin JL, Robitaillie Y, Boivin JF, et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 1993; 137: 342–54

    PubMed  Google Scholar 

  29. Lord SR, Sambrook PN, Gilbert C, et al. Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust 1994; 160: 684–91

    PubMed  CAS  Google Scholar 

  30. Studenski S, Duncan PW, Chandler J, et al. Predicting falls: the role of mobility and nonphysical factors. J Am Geriatr Soc 1994; 42: 297–302

    PubMed  CAS  Google Scholar 

  31. Lord SR, Anstey KJ, Williams P, et al. Psychoactive medication use, sensori-motor function and falls in older women. Br J Clin Pharm 1995; 39: 227–34

    Article  CAS  Google Scholar 

  32. Luukinen H, Koski K, Laippala P, et al. Predictors of recurrent falls among the home-dwelling elderly. Scand J Prim Health Care 1995; 13: 294–9

    Article  PubMed  CAS  Google Scholar 

  33. Sheahan SL, Coons SJ, Robbins CA, et al. Psychoactive medication, alcohol use, and falls among older adults. J Behav Med 1995; 18: 127–40

    Article  PubMed  CAS  Google Scholar 

  34. Maki BE, Holliday PJ, Topper AK. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol 1994; 49: M72–84

    PubMed  CAS  Google Scholar 

  35. Sobel KG, McCart GM. Drug use and accidental falls in an intermediate care facility. Drug Intell Clin Pharm 1983; 17: 539–42

    PubMed  CAS  Google Scholar 

  36. Wells BG, Middleton B, Lawrence G, et al. Factors associated with the elderly falling in intermediate care facilities. Drug Intell Clin Pharm 1985; 19: 142–5

    PubMed  CAS  Google Scholar 

  37. Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986; 80: 429–34

    Article  PubMed  CAS  Google Scholar 

  38. Kerman M, Mulvihill M. The role of medication in falls among the elderly in a long-term care facility. Mt Sinai J Med 1990; 57: 343–7

    PubMed  CAS  Google Scholar 

  39. Lipsitz LA, Jonsson PV, Kelley MM, et al. Causes and correlates of recurrent falls in ambulatory frail elderly. J Gerontol 1991; 46: M114–22

    PubMed  CAS  Google Scholar 

  40. Myers AH, Baker SP, Van Natta ML, et al. Risk factors associated with falls and injuries among elderly institutionalized persons. Am J Epidemiol 1991; 133: 1179–90

    PubMed  CAS  Google Scholar 

  41. Jantti PO, Pyykko VI, Hervonen ALJ. Falls among elderly nursing home residents. Public Health 1993; 107: 89–96

    Article  PubMed  CAS  Google Scholar 

  42. Ruthazer R, Lipsitz LA. Antidepressants and falls among elderly people in long-term care. Am J Public Health 1993; 83: 746–9

    Article  PubMed  CAS  Google Scholar 

  43. Yip YB, Cumming RG. The association between medications and falls in Australian nursing-home residents. Med J Aust 1994; 160: 14–8

    PubMed  CAS  Google Scholar 

  44. Luukinen H, Koski K, Laippala P, et al. Risk factors for recurrent falls in the elderly in long-term institutional care. Public Health 1995; 109: 57–65

    Article  PubMed  CAS  Google Scholar 

  45. Thapa PB, Gideon P, Fought RL, et al. Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents. Am J Epidemiol 1995; 142; 202–11

    PubMed  CAS  Google Scholar 

  46. Sorock GS. A case-control study of falling incidents among the hospitalized elderly. J Safety Res 1983; 14: 47–52

    Article  Google Scholar 

  47. Mayo NE, Korner-Bitensky N, Becker R, et al. Predicting falls among patients in a rehabilitation hospital. Am J Phys Med Rehabil 1989; 68: 139–46

    Article  PubMed  CAS  Google Scholar 

  48. Mion LC, Gregor S, Buettner M, et al. Falls in the rehabilitation setting: incidence and characteristics. Rehab Nursing 1989; 14: 17–22

    Article  CAS  Google Scholar 

  49. Byers V, Arrington ME, Finstuen K. Predictive risk factors associated with stroke patient falls in acute care settings. J Neurosci Nursing 1990; 22: 147–54

    Article  CAS  Google Scholar 

  50. Janken JK, Reynolds BA, Swiech K. Patient falls in the acute care setting: identifying risk factors. Nursing Res 1986; 35: 215–9

    Article  CAS  Google Scholar 

  51. Salgado R, Lord SR, Packer J, et al. Factors associated with falling in elderly hospital patients. Gerontology 1994; 40: 325–31

    Article  PubMed  CAS  Google Scholar 

  52. Gales BJ, Menard SM. Relationship between the adminstration of selected medications and falls in hospitalized elderly patients. Ann Pharmacother 1995; 29: 354–8

    PubMed  CAS  Google Scholar 

  53. Spar JE, La Rue A, Hewes C, et al. Multivariate prediction of falls in elderly inpatients. Int J Geriatr Psychiatry 1987; 2: 185–8

    Article  Google Scholar 

  54. Ray WA, Griffin MR, Schaffner W, et al. Psychotropic drug use and the risk of hip fracture. N Engl J Med 1987; 316: 363–9

    Article  PubMed  CAS  Google Scholar 

  55. Ray WA, Griffin MR, Malcolm E. Cyclic antidepressants and the risk of hip fracture. Arch Intern Med 1991; 151: 754–6

    Article  PubMed  CAS  Google Scholar 

  56. Thompson TL, Moran MG, Nies AS. Psychotropic drug use in the elderly. N Engl J Med 1983; 308: 194–9

    Article  PubMed  Google Scholar 

  57. Sorock GS, Shimkin EE. Benzodiazepine sedatives and the risk of falling in a community-dwelling elderly cohort. Arch Intern Med 1988; 148: 2441–4

    Article  PubMed  CAS  Google Scholar 

  58. Aisen PS, Deluca T, Lawlor BA. Falls among geropsychiatry inpatients are associated with PRN medications for agitation. Int J Geriatr Psychiatry 1992; 7: 709–12

    Article  Google Scholar 

  59. Ryynanen OP, Kivela SL, Honkanen R, et al. Medications and chronic diseases as risk factors for falling injuries in the elderly. Scand J Soc Med 1993; 21; 264–71

    PubMed  CAS  Google Scholar 

  60. Ray WA, Griffin MR, Downey W. Benzodiazepines of long and short elimination half-life and the risk of hip fracture. JAMA 1989; 262: 3303–7

    Article  PubMed  CAS  Google Scholar 

  61. Cumming RG, Klineberg RJ. Psychotropics, thiazide diuretics and hip fractures in the elderly. Med J Aust 1993; 158: 414–7

    PubMed  CAS  Google Scholar 

  62. Herings RMC, Stricker BHC, de Boer A, et al. Benzodiazepines and the risk of falling leading to femur fractures. Arch Intern Med 1995; 155: 1801–7

    Article  PubMed  CAS  Google Scholar 

  63. Isaac NE, Walker AM, Jick H, et al. Exposure to phenothiazine drags and risk of cataract. Arch Ophthalmol 1991; 109: 256–60

    Article  PubMed  CAS  Google Scholar 

  64. Cauley JA, Cummings SR, Seeley DG, et al. Effects of thiazide diuretic therapy on bone mass, fractures, and falls. Ann Intern Med 1993; 118: 666–73

    PubMed  CAS  Google Scholar 

  65. Ensrad KE, Nevitt MC, Yunis C, et al. Postural hypotension and postural dizziness in elderly women. Arch Intern Med 1992; 152: 1058–64

    Article  Google Scholar 

  66. Middler S, Pak CY, Murad F, et al. Thiazide diuretics and calcium metabolism. Metabolism 1973; 22: 139–46

    Article  PubMed  CAS  Google Scholar 

  67. Jones G, Nguyen T, Sambrook PN, et al. Thiazide diuretics and fractures: can meta-analysis help? J Bone Miner Res 1995; 10: 106–11

    PubMed  CAS  Google Scholar 

  68. Koski K, Luukinen H, Laippala P, et al. Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing 1996; 25: 29–38

    Article  PubMed  CAS  Google Scholar 

  69. Jonsson PV, Lipsitz LA, Kelley M, et al. Hypotensive responses to common daily activities in institutionalised elderly. Arch Intern Med 1990; 150: 1518–24

    Article  PubMed  CAS  Google Scholar 

  70. Hoppmann RA, Peden JG, Ober SK. Central nervous system side effects of nonsteroidal anti-inflammatory drags. Arch Intern Med 1991; 151: 1309–13

    Article  PubMed  CAS  Google Scholar 

  71. Bauer DC, Orwoll ES, Fox KM, et al. Aspirin and NSAID use in older women: effect on bone mineral density and fracture risk. J Bone Miner Res 1996; 11: 29–35

    Article  PubMed  CAS  Google Scholar 

  72. Shorr RI, Griffin MR, Daugherty JR, et al. Opioid analgesics and the risk of hip fracture in the elderly: codeine and propoxyphene. J Gerontol 1992; 47: M111–5

    PubMed  CAS  Google Scholar 

  73. Buck JA. Psychotropic drag practice in nursing homes. J Am Geriatr Soc 1988; 36: 409–18

    PubMed  CAS  Google Scholar 

  74. Liu BA, Topper AK, Reeves RA, et al. Falls among older people: relationship to medication use and orthostatic hypotension. J Am Geriatr Soc 1995; 43: 1141–5

    PubMed  CAS  Google Scholar 

  75. Avorn J, Soumerai SB, Everitt DE, et al. A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992; 327: 168–73

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Public Health and Community Medicine, University of Sydney, Sydney, New South Wales, Australia

    Robert G. Cumming

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Cumming, R.G. Epidemiology of Medication-Related Falls and Fractures in the Elderly. Drugs Aging 12, 43–53 (1998). https://doi.org/10.2165/00002512-199812010-00005

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