Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON N6A 5C1, Canada; Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON N6C 0A7, Canada.
Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON N6C 0A7, Canada.
Ageing Res Rev. 2022 May;77:101599. doi: 10.1016/j.arr.2022.101599. Epub 2022 Feb 24.
Medication use, and gait impairment are two major risk factors for falls in older adults. There are several mechanisms linking fall risk-increasing drugs (FRIDs) and increased fall risk. One pathway involves gait performance as an intermediate variable. It is plausible that FRIDs indirectly increase fall risk by causing gait impairment. The purpose of this review was to systematically review the existing evidence on the association between FRIDs and gait performance in community-dwelling older adults without neurological movement disorders.
Two searches were performed using MeSH terms and keywords in the electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL and grey literature. We included clinical trials and observational studies that assessed the association between a FRID class and any quantitative measure of gait performance. Quality assessment was performed using the Newcastle-Ottawa scale for observational studies and the Cochrane risk-of-bias tool for clinical trials. Study characteristics and findings were summarized in a descriptive approach for each drug class.
A total of 11,197 studies were retrieved from both searches at the first step and a total of 23 studies met the final inclusion criteria. Fourteen studies assessed the association between psychotropic FRIDs and gait performance and nine assessed cardiovascular FRIDs. Four out of five studies found that drugs with sedative properties are associated with reduced gait speed in older adults. Three out of four studies found no association between statin use and gait speed. There is insufficient evidence on the association between FRIDs and other gait performance measures.
Caution should be taken when prescribing drugs with sedative properties to older adults at risk of falls. Further research is required to assess the impact of the use FRIDs on gait performance measures other than gait speed.
药物使用和步态障碍是导致老年人跌倒的两个主要危险因素。有几种机制将增加跌倒风险的药物（FRIDs）与增加跌倒风险联系起来。一种途径涉及步态表现作为中间变量。FRIDs 通过导致步态障碍间接增加跌倒风险是合理的。本综述的目的是系统地回顾社区居住的无神经运动障碍的老年人中 FRIDs 与步态表现之间的现有证据。
使用电子数据库 MEDLINE、EMBASE、PsycINFO、CINAHL 和灰色文献中的 MeSH 术语和关键字进行了两次搜索。我们纳入了评估 FRID 类与任何步态表现定量测量之间关联的临床试验和观察性研究。使用纽卡斯尔-渥太华量表对观察性研究进行质量评估，使用 Cochrane 偏倚风险工具对临床试验进行质量评估。按药物类别对研究特征和发现进行描述性总结。
从两次搜索的第一步中总共检索到 11197 项研究，共有 23 项研究符合最终纳入标准。14 项研究评估了精神药物 FRIDs 与步态表现之间的关联，9 项研究评估了心血管 FRIDs。五项研究中有四项发现具有镇静作用的药物与老年人的步速降低有关。四项研究中有三项发现他汀类药物使用与步速之间没有关联。关于 FRIDs 与其他步态表现测量之间的关联，证据不足。
对于有跌倒风险的老年人，在开具有镇静作用的药物时应谨慎。需要进一步研究评估 FRIDs 使用对除步速以外的其他步态表现测量的影响。
