Mercer's Institute of Successful Ageing, St James's Hospital, Dublin, Ireland.
Department of Emergency Medicine, St James's Hospital, Dublin, Ireland.
Eur Geriatr Med. 2023 Jun;14(3):455-463. doi: 10.1007/s41999-023-00786-x. Epub 2023 May 9.
Psychotropic medications (antidepressants, anticholinergics, benzodiazepines, 'Z'-drugs and antipsychotics) are frequently identified as Falls Risk Increasing Drugs. The aim of this study is to clarify the association of psychotropic medication use with future falls/fracture amongst community-dwelling older people.
Participants ≥ 65 years from TILDA were included and followed from Waves 1 to 5 (8-year follow-up). Incidence of falls (total falls/unexplained/injurious) and fracture was by self-report; unexplained falls were falls not caused by a slip/trip, with no apparent cause. Poisson regression models reporting incidence rate ratios (IRR) assessed the association between medications and future falls/fracture, adjusted for relevant covariates.
Of 2809 participants (mean age 73 years), 15% were taking ≥ 1 psychotropic medication. During follow-up, over half of participants fell, with 1/3 reporting injurious falls, over 1/5 reporting unexplained falls and almost 1/5 reporting fracture. Psychotropic medications were independently associated with falls [IRR 1.15 (95% CI 1.00-1.31)] and unexplained falls [IRR 1.46 (95% CI 1.20-1.78)]. Taking ≥ 2 psychotropic medications was further associated with future fracture (IRR 1.47 (95% CI 1.06-2.05)]. Antidepressants were independently associated with falls [IRR 1.20 (1.00-1.42)] and unexplained falls [IRR 2.12 (95% CI 1.69-2.65)]. Anticholinergics were associated with unexplained falls [IRR 1.53 (95% CI 1.14-2.05)]. 'Z'-drug and benzodiazepine use were not associated with falls or fractures.
Psychotropic medications, particularly antidepressants and anticholinergic medications, are independently associated with falls and fractures. Regular review of ongoing need for these medications should therefore be central to the comprehensive geriatric assessment.
精神药物（抗抑郁药、抗胆碱能药、苯二氮䓬类药物、“Z”类药物和抗精神病药）常被认为是增加跌倒风险的药物。本研究旨在阐明精神药物的使用与社区居住的老年人未来跌倒/骨折的关系。
本研究纳入了 TILDA 研究中的年龄≥65 岁的参与者，并对其进行了从第 1 波到第 5 波（8 年随访）的随访。通过自我报告评估跌倒（总跌倒/无明显原因的跌倒/有伤害的跌倒）和骨折的发生率；无明显原因的跌倒指非因滑倒/绊倒引起的、无明显原因的跌倒。采用报告发病率比（IRR）的泊松回归模型，调整了相关协变量后，评估了药物与未来跌倒/骨折之间的关系。
在 2809 名参与者中（平均年龄 73 岁），15%的参与者服用了≥1 种精神药物。在随访期间，超过一半的参与者跌倒，其中 1/3 报告有伤害性跌倒，超过 1/5 报告无明显原因的跌倒，近 1/5 报告骨折。精神药物与跌倒[IRR 1.15（95%CI 1.00-1.31）]和无明显原因的跌倒[IRR 1.46（95%CI 1.20-1.78）]独立相关。服用≥2 种精神药物与未来骨折进一步相关[IRR 1.47（95%CI 1.06-2.05）]。抗抑郁药与跌倒[IRR 1.20（1.00-1.42）]和无明显原因的跌倒[IRR 2.12（95%CI 1.69-2.65）]独立相关。抗胆碱能药与无明显原因的跌倒相关[IRR 1.53（95%CI 1.14-2.05）]。“Z”类药物和苯二氮䓬类药物的使用与跌倒或骨折无关。
精神药物，特别是抗抑郁药和抗胆碱能药物，与跌倒和骨折独立相关。因此，这些药物的持续需求应定期进行审查，这应成为全面老年评估的核心内容。
