Rozenfeld Suely, Camacho Luiz Antonio Bastos, Veras Peixoto
Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Rua Leopoldo Bulhões, 1480, 8 masculine Andar, Manguinhos, Rio de Janeiro-RJ, Brazil.
Rev Panam Salud Publica. 2003 Jun;13(6):369-75. doi: 10.1590/s1020-49892003000500005.
To assess the prevalence of falls and their association with the use of medications among elderly women in the city of Rio de Janeiro, Brazil. Falls among the elderly are likely to gain additional public health importance in Brazil and many other developing countries given the rapid growth of the elderly populations in those nations.
A cross-sectional study was carried out with women who were participating in the educational, cultural, and medical care activities of the Open University of the Third Age (OUTA), a group that works to promote the welfare of elderly people in the city of Rio de Janeiro. The women in the study were all 60 years old or older, were able to walk, had no cognitive impairment, and were living in the community (rather than living in a facility exclusively for older persons). A questionnaire was used that asked about falls within the 12 months prior to the interview, medications used in the previous 15 days, current and past health problems, and demographic characteristics. Women who were interviewed face-to-face also had their blood pressure checked. Two outcome variables were defined: (1) "fallers," who had suffered one or more falls (contrasted with "nonfallers") and (2) "recurrent fallers," who had had two or more falls (contrasted with those who had had one or no falls, called "nonrecurrent fallers").
A total of 634 women were interviewed face-to-face at the OUTA facilities. Among these in-person interviewees, 23.3% reported one fall in the previous year, and 14.0% reported two or more falls in that period. Considering both prescribed drugs and over-the-counter drugs, only 9.1% of these women were not using any medications, 52.7% were using 1 to 4 medications, 34.4% were using 5 to 10, and 3.8% were using 11 to 17 medications. In comparison to nonusers, users of diuretics who also suffered from musculoskeletal disease were 1.6 times as likely to report having suffered a single fall in the preceding year, after adjusting for cardiovascular disease. Recurrent falls were reported 2.0 times as often among beta-blocker users as among nonusers, after adjusting for cardiovascular disease. The risk of recurrent falls among users of anxiolytics/sedatives who had postural hypotension was 4.9 times as high as among nonusers.
Our data indicate an association between single falls and recurrent falls and several groups of medications. Some falls could be avoided through the more rational use of drugs, and measures should be developed and implemented to encourage this.
评估巴西里约热内卢市老年女性跌倒的发生率及其与药物使用的关联。鉴于巴西和许多其他发展中国家老年人口的快速增长，老年人跌倒问题可能在公共卫生方面具有更大的重要性。
对参与第三年龄开放大学（OUTA）教育、文化和医疗保健活动的女性进行了一项横断面研究，该组织致力于促进里约热内卢市老年人的福利。研究中的女性年龄均在60岁及以上，能够行走，无认知障碍，且居住在社区（而非专门为老年人设立的机构）。使用了一份问卷，询问访谈前12个月内的跌倒情况、过去15天内使用的药物、当前和过去的健康问题以及人口统计学特征。接受面对面访谈的女性还测量了血压。定义了两个结局变量：（1）“跌倒者”，即经历过一次或多次跌倒的人（与“非跌倒者”相对）；（2）“反复跌倒者”，即经历过两次或更多次跌倒的人（与跌倒一次或未跌倒的人相对，后者称为“非反复跌倒者”）。
共有634名女性在OUTA设施接受了面对面访谈。在这些面对面访谈对象中，23.3%报告上一年有过一次跌倒，14.0%报告在该时期有过两次或更多次跌倒。考虑处方药和非处方药，这些女性中只有9.1%未使用任何药物，52.7%使用1至4种药物，34.4%使用5至10种，3.8%使用11至17种药物。与未使用者相比，患有肌肉骨骼疾病且使用利尿剂的人在调整心血管疾病因素后，报告上一年有过单次跌倒的可能性是未使用者的1.6倍。在调整心血管疾病因素后，β受体阻滞剂使用者报告反复跌倒的频率是未使用者的2.0倍。有体位性低血压且使用抗焦虑药/镇静剂的人反复跌倒的风险是未使用者的4.9倍。
我们的数据表明单次跌倒和反复跌倒与几类药物之间存在关联。通过更合理地使用药物可以避免一些跌倒情况，应制定并实施相关措施来鼓励这种做法。
