Woolcott John C, Richardson Kathryn J, Wiens Matthew O, Patel Bhavini, Marin Judith, Khan Karim M, Marra Carlo A
Faculty of Pharmaceutical Sciences, University of British Columbia, BC, Canada.
Arch Intern Med. 2009 Nov 23;169(21):1952-60. doi: 10.1001/archinternmed.2009.357.
There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis.
Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs)
Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); beta-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for beta-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment.
The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.
人们越来越认识到某些药物的使用会导致老年人跌倒。我们的目标是更新之前完成的一项荟萃分析，该分析着眼于药物使用与跌倒之间的关联，以纳入相关药物类别以及自上次荟萃分析以来完成的新研究。
通过系统检索1996年至2007年发表的英文文章来确定研究。我们确定了针对60岁以上患者完成的研究，着眼于药物使用与跌倒之间的关联。贝叶斯方法使我们能够将之前荟萃分析的结果与新信息相结合，以估计更新后的贝叶斯比值比（OR）和95%可信区间（95%CrI）。
在11118篇已识别的文章中，22篇符合我们的纳入标准。对9种独特的药物类别进行了荟萃分析，包括79081名参与者，以下是未经调整的贝叶斯OR估计值：抗高血压药，OR为1.24（95%CrI为1.01 - 1.50）；利尿剂，OR为1.07（95%CrI为1.01 - 1.14）；β受体阻滞剂，OR为1.01（95%CrI为0.86 - 1.17）；镇静催眠药，OR为1.47（95%CrI为1.35 - 1.62）；抗精神病药，OR为1.59（95%CrI为1.37 - 1.83）；抗抑郁药，OR为1.68（95%CrI为1.47 - 1.91）；苯二氮䓬类药物，OR为1.57（95%CrI为1.43 - 1.72）；麻醉药，OR为0.96（95%CrI为0.78 - 1.18）；非甾体抗炎药，OR为1.21（95%CrI为1.01 - 1.44）。利尿剂、抗精神病药、抗抑郁药和苯二氮䓬类药物经调整后的贝叶斯OR估计值分别为0.99（95%CrI为0.78 - 1.25）、1.39（95%CrI为0.94 - 2.00）、1.36（95%CrI为1.13 - 1.76）和1.41（95%CrI为1.20 - 1.71）。研究分层对贝叶斯OR估计值影响不大，在不同人群（β受体阻滞剂、抗精神病药）和研究类型（镇静催眠药、苯二氮䓬类药物、麻醉药）中观察到的分层OR仅有微小差异。在被认为具有“良好”药物和跌倒确定情况的研究中，使用镇静催眠药、抗精神病药、抗抑郁药、苯二氮䓬类药物和非甾体抗炎药时，跌倒的可能性增加。
使用镇静催眠药、抗抑郁药和苯二氮䓬类药物与老年人跌倒之间存在显著关联。
