Cumming R G
Department of Public Health and Community Medicine, University of Sydney, New South Wales, Australia.
Drugs Aging. 1998 Jan;12(1):43-53. doi: 10.2165/00002512-199812010-00005.
About 30% of people aged over 65 years living in the community fall at least once a year; the fall rate is even higher in nursing homes. Many of these falls lead to fractures, the most serious type being hip fractures. Whether or not the use of various medications causes falls and fractures has been the subject of more than 50 observational epidemiological studies, most published after 1988. Few of these studies were specifically designed to investigate the associations between medication use and falls, so most have methodological limitations. Uncontrolled confounding factors are a particular problem. It is important to recognise these flaws in study design when reviewing the scientific literature on the link between medications and falls and fractures. Patients taking psychotropic medications appear to have about a 2-fold increased risk of falls and fractures, compared with individuals not taking these drugs. The strongest evidence is for antidepressants; nearly every relevant study has found an association with falls. The relative effect of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors and tricyclic antidepressants on falls is still unknown. The effect on the risk of falling of short-acting versus long-acting benzodiazepines is not straightforward: it may be the benzodiazepine dosage that matters, rather than the drug half-life. Whether or not any medications used to treat cardiovascular problems cause falls remains unclear. Current evidence suggests that diuretics, in general, do not cause falls and that thiazide diuretics, in particular, may help prevent fractures by slowing the development of osteoporosis. Some studies have found that use of nonsteroidal anti-inflammatory drugs is associated with falling; this deserves further study. Reducing the use of psychotropic drugs by residents of nursing homes should be a high priority for physicians, pharmacists and nursing staff. Psychotropic drug use should also be kept to a minimum among older people living in the community.
居住在社区中的65岁以上老人，约30%每年至少跌倒一次；养老院中的跌倒率更高。这些跌倒事件很多会导致骨折，其中最严重的是髋部骨折。使用各种药物是否会导致跌倒和骨折，一直是50多项观察性流行病学研究的主题，其中大部分研究在1988年之后发表。这些研究中很少有专门设计用于调查药物使用与跌倒之间的关联，因此大多数研究存在方法学上的局限性。未控制的混杂因素是一个特别的问题。在回顾关于药物与跌倒和骨折之间联系的科学文献时，认识到研究设计中的这些缺陷很重要。与未服用这些药物的个体相比，服用精神药物的患者跌倒和骨折的风险似乎增加了约两倍。最有力的证据是针对抗抑郁药；几乎每项相关研究都发现其与跌倒有关。选择性5-羟色胺再摄取抑制剂和三环类抗抑郁药对跌倒的相对影响仍不清楚。短效与长效苯二氮䓬类药物对跌倒风险的影响并不简单：可能重要的是苯二氮䓬类药物的剂量，而非药物半衰期。用于治疗心血管问题的任何药物是否会导致跌倒仍不清楚。目前的证据表明，一般来说，利尿剂不会导致跌倒，特别是噻嗪类利尿剂可能通过减缓骨质疏松症的发展来帮助预防骨折。一些研究发现，使用非甾体抗炎药与跌倒有关；这值得进一步研究。养老院居民减少精神药物的使用，应是医生、药剂师和护理人员的高度优先事项。社区中老年人的精神药物使用也应保持在最低限度。
