Cumming R G, Miller J P, Kelsey J L, Davis P, Arfken C L, Birge S J, Peck W A
Division of Epidemiology, School of Public Health, Columbia University, New York, NY 10032.
Age Ageing. 1991 Nov;20(6):455-61. doi: 10.1093/ageing/20.6.455.
The purpose of this study was to identify associations between the use of commonly taken medications and groups of medications and the risk of falls in elderly people living in the community. A stratified random sample of 1358 persons aged 65 years and over was selected from the 15,000 members of an educational organization for functionally independent, community-dwelling elderly people in St Louis, Missouri. Twenty-seven per cent of subjects reported at least one fall in the past year and 8% reported two or more falls. After adjusting for potential confounders (including age, sex, relevant medical conditions, health status, cognitive impairment, use of alcohol, depression and use of other medications), the following medications were found to be important risk factors for multiple falls: diazepam [odds ratio (OR): 3.7, 95% confidence interval (CI): 1.5-9.3], diltiazem (OR: 1.8, 95% CI: 0.8-4.1), diuretics (OR: 1.8, 95% CI: 1.2-2.8) and laxatives (OR: 2.1, 95% CI: 1.0-4.5). We conclude that caution is needed before prescribing diuretics and psychotropics, especially diazepam, for elderly people. The safety of diltiazem in this age group should be assessed further.
本研究的目的是确定常用药物及药物类别与社区老年人群跌倒风险之间的关联。从密苏里州圣路易斯市一个针对功能独立的社区居住老年人的教育组织的15000名成员中，选取了1358名65岁及以上的分层随机样本。27%的受试者报告在过去一年中至少跌倒过一次，8%的受试者报告跌倒过两次或更多次。在对潜在混杂因素（包括年龄、性别、相关医疗状况、健康状况、认知障碍、酒精使用、抑郁及其他药物使用）进行调整后，发现以下药物是多次跌倒的重要危险因素：地西泮[比值比（OR）：3.7，95%置信区间（CI）：1.5 - 9.3]、地尔硫䓬（OR：1.8，95% CI：0.8 - 4.1）、利尿剂（OR：1.8，95% CI：1.2 - 2.8）和泻药（OR：2.1，95% CI：1.0 - 4.5）。我们得出结论，在为老年人开利尿剂和精神药物尤其是地西泮时需要谨慎。该年龄组使用地尔硫䓬的安全性应进一步评估。
