Janus Sarah I M, Reinders Gezinus H, van Manen Jeannette G, Zuidema Sytse U, IJzerman Maarten J
Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Drugs R D. 2017 Jun;17(2):321-328. doi: 10.1007/s40268-017-0181-0.
Older people are more susceptible to falls than younger people. Therefore, as the Dutch population ages, the total number of falls and costs associated with them will rise. The use of psychotropic drugs is associated with an increased risk of falling. To create tailored fall-prevention programmes, information on the magnitude of the association between fall incidents and specific psychotropic drugs or drug classes is needed.
The goal of this study was to delineate the associations between fall incidents and specific psychotropic drugs or drug classes.
In this retrospective cohort study, electronic patient records, medication records and fall incident reports were collected for 1415 residents receiving somatic or psychogeriatric care in 22 nursing homes in the eastern part of the Netherlands from May 2012 until March 2015. Using a Cox proportional hazards model, we analysed the magnitude of the association between psychotropic drugs and the risk of falling for users and non-users of the psychotropic drugs or drug classes.
Antipsychotics (adjusted hazard ratio [aHR] 1.49; 95% confidence interval [CI] 1.12-2.00) and hypnotics and sedatives (aHR 1.51; 95% CI 1.13-2.02) increase the risk of falling. There was no difference between the risk incurred by typical and atypical antipsychotics. However, within these groups, there were differences between the most commonly prescribed drugs: haloperidol and quetiapine were seen to have an association with falls, whereas pipamperone and risperidone were not.
The results suggest falls may be associated with individual drugs rather than drug classes. Within the drug classes, clear differences are evident between individual drugs. Future fall-prevention programmes should highlight the differential risks involved with the use of specific psychotropic drugs, and doctors should take the fall risk into account when choosing specific drugs.
老年人比年轻人更容易跌倒。因此，随着荷兰人口老龄化，跌倒的总数及其相关成本将会上升。使用精神药物会增加跌倒风险。为了制定针对性的预防跌倒计划，需要了解跌倒事件与特定精神药物或药物类别之间关联程度的信息。
本研究的目的是描述跌倒事件与特定精神药物或药物类别之间的关联。
在这项回顾性队列研究中，收集了2012年5月至2015年3月期间荷兰东部22家养老院中1415名接受躯体或老年精神护理的居民的电子病历、用药记录和跌倒事件报告。我们使用Cox比例风险模型分析了精神药物使用者和非使用者中精神药物与跌倒风险之间关联的程度。
抗精神病药物（调整后风险比[aHR]为1.49；95%置信区间[CI]为1.12 - 2.00）以及催眠药和镇静药（aHR为1.51；95%CI为1.13 - 2.02）会增加跌倒风险。典型抗精神病药物和非典型抗精神病药物引发的风险没有差异。然而，在这些组中，最常用药物之间存在差异：氟哌啶醇和喹硫平被发现与跌倒有关，而匹泮哌隆和利培酮则无关。
结果表明跌倒可能与个别药物而非药物类别有关。在药物类别中，个别药物之间存在明显差异。未来的预防跌倒计划应突出使用特定精神药物所涉及的不同风险，医生在选择特定药物时应考虑跌倒风险。
