Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study
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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.
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.
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.
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.
KeywordsTimolol Medication Group Fall Risk Handgrip Strength Fall Incident
The authors gratefully thank all study participants and all dedicated co-workers who helped in the success of the B-PROOF trial, especially S. Smits, R.N.; P.H. in ‘t Veld, MSc; M. Hillen-Tijdink; A. Nicolaas-Merkus; and N. Pliester. In addition, we thank SFK for their cooperation and for providing the pharmacy dispensing records, especially J. Lukaart, MSc.
B-PROOF is supported and funded by The Netherlands Organization for Health Research and Development (ZonMw, Grant 6130.0031 and 11-31010-06), the Hague; unrestricted grant from NZO (Dutch Dairy Association), Zoetermeer; NCHA (Netherlands Consortium for Healthy Ageing) Leiden/ Rotterdam; Ministry of Economic Affairs, Agriculture and Innovation (project KB-15-004-003), the Hague; Wageningen University, Wageningen; VU University Medical Centre, Amsterdam; Erasmus Medical Center, Rotterdam. All organisations are based in the Netherlands. The sponsors do not have any role in the design or implementation of the study, data collection, data management, data analysis, data interpretation, or in the preparation, review, or approval of the manuscript.
The authors have no potential conflicts of interest that are directly relevant to the content of this study.
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