Hanlon Joseph T, Boudreau Robert M, Roumani Yazan F, Newman Anne B, Ruby Christine M, Wright Rollin M, Hilmer Sarah N, Shorr Ronald I, Bauer Douglas C, Simonsick Eleanor M, Studenski Stephanie A
Department of Medicine, Geriatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Gerontol A Biol Sci Med Sci. 2009 Apr;64(4):492-8. doi: 10.1093/gerona/gln043. Epub 2009 Feb 4.
Few studies have examined the risk of multiple or high doses of combined central nervous system (CNS) medication use for recurrent falls in the elderly. The study objective was to evaluate whether multiple- or high-dose CNS medication use in older adults was associated with a higher risk of recurrent (>or=2) falls.
This longitudinal cohort study included 3,055 participants from the Health, Aging and Body Composition study who were well functioning at baseline. CNS medication use (benzodiazepine and opioid receptor agonists, antipsychotics, antidepressants) was determined annually (except Year 4) during in-person interviews. The number and summated standard daily doses (SDDs; low, medium, and high) of CNS medications were computed. Falls 1 year later were ascertained annually for 5 years.
For a period of 5 years, as many as 24.1% of CNS medication users took 2+ agents annually, whereas as no more than 18.9% of CNS medication users took high doses annually (3+ SDDs). Yearly, as many as 9.7% of participants reported recurrent falls. Multivariable Generalized Estimating Equation analyses showed that multiple CNS medication users compared with never users had an increased risk of sustaining 2+ falls (adjusted odds ratio [OR] 1.95; 95% confidence interval [CI] 1.35-2.81). Those taking high (3+) CNS SDDs also exhibited an increased risk of 2+ falls (adjusted OR 2.89; 95% CI 1.96-4.25).
Higher total daily doses of CNS medications were associated with recurrent falls. Further studies are needed to determine the impact of reducing the number of CNS medications and/or dosage on recurrent falls.
很少有研究探讨使用多种或高剂量的中枢神经系统（CNS）联合用药与老年人反复跌倒风险之间的关系。本研究的目的是评估老年人使用多种或高剂量CNS药物是否与反复（≥2次）跌倒的较高风险相关。
这项纵向队列研究纳入了来自健康、衰老和身体成分研究的3055名参与者，他们在基线时功能良好。在面对面访谈期间，每年（第4年除外）确定CNS药物的使用情况（苯二氮卓类和阿片受体激动剂、抗精神病药、抗抑郁药）。计算CNS药物的数量和每日标准剂量总和（SDDs；低、中、高）。在5年时间里，每年确定1年后的跌倒情况。
在5年期间，多达24.1%的CNS药物使用者每年服用2种以上药物，而每年服用高剂量（3种以上SDDs）的CNS药物使用者不超过18.9%。每年，多达9.7%的参与者报告有反复跌倒。多变量广义估计方程分析显示，与从未使用过CNS药物的使用者相比，使用多种CNS药物的使用者发生2次以上跌倒的风险增加（调整后的优势比[OR]为1.95；95%置信区间[CI]为1.35-2.81）。服用高剂量（3种以上）CNS SDDs的使用者发生2次以上跌倒的风险也增加（调整后的OR为2.89；95%CI为1.96-4.25）。
CNS药物的每日总剂量较高与反复跌倒有关。需要进一步研究以确定减少CNS药物数量和/或剂量对反复跌倒的影响。
