Neutel C Ineke, Perry Sheril, Maxwell Colleen
University of Ottawa Institute on Health of the Elderly, 43 Bruyère Street, Ottawa, Ontario, Canada, K1N 5C8.
Pharmacoepidemiol Drug Saf. 2002 Mar;11(2):97-104. doi: 10.1002/pds.686.
Injuries due to falls are an important public health concern, particularly for the elderly, and effective prevention is an ongoing endeavour. The present study has two related objectives: (1) to describe associations between drug use and falls in an institutionalized population, and (2) to identify a high risk subgroup within the larger population.
The initial analysis was based on a population of 227 residents who were followed over a 1-year period. Logistic regression techniques were used to estimate odds ratios (ORs) of the association of falls and drug use. The study of potential 'high-risk' groups employed a case-crossover design to estimate the risk of falling associated with starting a new drug course.
Relatively weak ORs for risk of falling were observed for various drug classes; the highest OR was for benzodiazepines (BZD) at OR = 1.8 (unadjusted). Residents taking multiple drugs were at particular risk for falling, e.g. an OR of 6.1 for those using 10+ drugs. The case-crossover analysis indicated that residents starting a new BZD/antipsychotic were at very high risk (OR = 11.4) for experiencing a fall.
Residents who took many different types of medications, as well as residents starting a new BZD/antipsychotics were at greatly increased risk of falling. These are high risk groups where increased monitoring or adjustments to drug regimens could lead to prevention of falls.
跌倒所致伤害是一个重要的公共卫生问题，对老年人尤为如此，有效的预防工作一直在进行。本研究有两个相关目标：（1）描述在机构化人群中药物使用与跌倒之间的关联，（2）在更大的人群中识别高风险亚组。
初始分析基于227名居民的群体，对其进行了为期1年的跟踪。采用逻辑回归技术来估计跌倒与药物使用关联的比值比（OR）。对潜在“高风险”群体的研究采用病例交叉设计来估计开始新的药物疗程与跌倒风险之间的关系。
观察到各类药物跌倒风险的OR相对较弱；最高的OR是苯二氮䓬类药物（BZD），未调整的OR = 1.8。服用多种药物的居民跌倒风险尤其高，例如，使用10种及以上药物的居民OR为6.1。病例交叉分析表明，开始使用新的BZD/抗精神病药物的居民跌倒风险非常高（OR = 11.4）。
服用多种不同类型药物的居民，以及开始使用新的BZD/抗精神病药物的居民跌倒风险大幅增加。这些是高风险群体，加强监测或调整药物治疗方案可能有助于预防跌倒。
