Richardson Kathryn, Bennett Kathleen, Kenny Rose Anne
Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland The Irish Longitudinal Study on Ageing, Chemistry Extension Building, Trinity College Dublin, Dublin, Ireland.
Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
Age Ageing. 2015 Jan;44(1):90-6. doi: 10.1093/ageing/afu141. Epub 2014 Oct 12.
polypharmacy is an important risk factor for falls, but recent studies suggest only when including medications associated with increasing the risk of falls.
a prospective, population-based cohort study.
6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing.
participants reported regular medication use at baseline. Any subsequent falls, any injurious falls and the number of falls were reported 2 years later. The association between polypharmacy (>4 medications) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression. The association with the number of falls was assessed using negative binomial regression.
during follow-up, 231 falls per 1,000 person-years were reported. Polypharmacy including antidepressants was associated with a greater risk of any fall (adjusted relative risk (aRR) 1.28, 95% CI 1.06-1.54), of injurious falls (aRR 1.51, 95% CI 1.10-2.07) and a greater number of falls (adjusted incident rate ratio (aIRR) 1.60, 95% CI 1.19-2.15), but antidepressant use without polypharmacy and polypharmacy without antidepressants were not. The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy (aRR 1.40, 95% CI 1.04-1.87), but was associated with a greater number of falls (aIRR 1.32, 95% CI 1.05-1.65), independent of polypharmacy. Other medications assessed, including antihypertensives, diuretics and antipsychotics, were not associated with outcomes.
in middle-aged and older adults, polypharmacy, including antidepressant or benzodiazepine use, was associated with injurious falls and a greater number of falls.
多重用药是跌倒的一个重要风险因素，但最近的研究表明，只有在纳入与跌倒风险增加相关的药物时才成立。
一项基于人群的前瞻性队列研究。
来自爱尔兰老龄化纵向研究的6666名年龄≥50岁的成年人。
参与者在基线时报告常规用药情况。2年后报告任何后续跌倒、任何伤害性跌倒及跌倒次数。使用修正泊松回归评估多重用药（>4种药物）或增加跌倒风险的药物与后续跌倒或伤害性跌倒之间的关联。使用负二项回归评估与跌倒次数的关联。
随访期间，每1000人年报告231次跌倒。包括抗抑郁药在内的多重用药与任何跌倒（调整后相对风险[aRR]1.28，95%置信区间[CI]1.06 - 1.54）、伤害性跌倒（aRR 1.51，95% CI 1.10 - 2.07）以及更多跌倒次数（调整后发病率比[aIRR]1.60，95% CI 1.19 - 2.15）的风险增加相关，但单纯使用抗抑郁药而无多重用药以及多重用药但无抗抑郁药的情况则不然。苯二氮䓬类药物与多重用药同时使用时与伤害性跌倒相关（aRR 1.40，95% CI 1.04 - 1.87），但与更多跌倒次数相关（aIRR 1.32，95% CI 1.05 - 1.65），且与多重用药无关。评估的其他药物，包括抗高血压药、利尿剂和抗精神病药，与结局无关。
在中老年人中，包括使用抗抑郁药或苯二氮䓬类药物在内的多重用药与伤害性跌倒及更多跌倒次数相关。
