Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study

A.C. Ham, K.M.A. Swart, A.W. Enneman, S.C. van Dijk, S.O. Araghi, J.P. van Wijngaarden, N.L. van der Zwaluw, E.M. Brouwer, R.A.M. Dhonukshe-Rutten, N.M. van Schoor, T.J.M. van der Cammen, P. Lips, A.G. Uitterlinden, R.F. Witkamp, B.H. Stricker, N. van der Velde, C.P.G.M. de Groot

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. Methods Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged >= 65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. Results During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95 % confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95 % CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95 % CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95 % CI 1.02-1.71]), and antidepressant use (HR 1.40 [95 % CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. Conclusion Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.
Original languageEnglish
Pages (from-to)917-927
JournalDrugs & Aging
Volume31
Issue number12
DOIs
Publication statusPublished - 2014

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Vitamin B Complex
Osteoporotic Fractures
Confidence Intervals
Independent Living
Population
Anti-Arrhythmia Agents
Odds Ratio
Benzodiazepines
Antidepressive Agents
Accidental Falls
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiovascular Agents
Psychotropic Drugs
Proportional Hazards Models
Pharmaceutical Preparations
Health Status

Keywords

  • randomized controlled-trial
  • risk-increasing drugs
  • primary-care database
  • physical performance
  • ophthalmic timolol
  • psychotropic-drugs
  • case-series
  • people
  • metaanalysis
  • community

Cite this

Ham, A. C., Swart, K. M. A., Enneman, A. W., van Dijk, S. C., Araghi, S. O., van Wijngaarden, J. P., ... de Groot, C. P. G. M. (2014). Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study. Drugs & Aging, 31(12), 917-927. https://doi.org/10.1007/s40266-014-0225-x
Ham, A.C. ; Swart, K.M.A. ; Enneman, A.W. ; van Dijk, S.C. ; Araghi, S.O. ; van Wijngaarden, J.P. ; van der Zwaluw, N.L. ; Brouwer, E.M. ; Dhonukshe-Rutten, R.A.M. ; van Schoor, N.M. ; van der Cammen, T.J.M. ; Lips, P. ; Uitterlinden, A.G. ; Witkamp, R.F. ; Stricker, B.H. ; van der Velde, N. ; de Groot, C.P.G.M. / Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study. In: Drugs & Aging. 2014 ; Vol. 31, No. 12. pp. 917-927.
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title = "Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study",
abstract = "Background Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. Methods Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged >= 65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. Results During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95 {\%} confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95 {\%} CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95 {\%} CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95 {\%} CI 1.02-1.71]), and antidepressant use (HR 1.40 [95 {\%} CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. Conclusion Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.",
keywords = "randomized controlled-trial, risk-increasing drugs, primary-care database, physical performance, ophthalmic timolol, psychotropic-drugs, case-series, people, metaanalysis, community",
author = "A.C. Ham and K.M.A. Swart and A.W. Enneman and {van Dijk}, S.C. and S.O. Araghi and {van Wijngaarden}, J.P. and {van der Zwaluw}, N.L. and E.M. Brouwer and R.A.M. Dhonukshe-Rutten and {van Schoor}, N.M. and {van der Cammen}, T.J.M. and P. Lips and A.G. Uitterlinden and R.F. Witkamp and B.H. Stricker and {van der Velde}, N. and {de Groot}, C.P.G.M.",
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Ham, AC, Swart, KMA, Enneman, AW, van Dijk, SC, Araghi, SO, van Wijngaarden, JP, van der Zwaluw, NL, Brouwer, EM, Dhonukshe-Rutten, RAM, van Schoor, NM, van der Cammen, TJM, Lips, P, Uitterlinden, AG, Witkamp, RF, Stricker, BH, van der Velde, N & de Groot, CPGM 2014, 'Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study' Drugs & Aging, vol. 31, no. 12, pp. 917-927. https://doi.org/10.1007/s40266-014-0225-x

Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study. / Ham, A.C.; Swart, K.M.A.; Enneman, A.W.; van Dijk, S.C.; Araghi, S.O.; van Wijngaarden, J.P.; van der Zwaluw, N.L.; Brouwer, E.M.; Dhonukshe-Rutten, R.A.M.; van Schoor, N.M.; van der Cammen, T.J.M.; Lips, P.; Uitterlinden, A.G.; Witkamp, R.F.; Stricker, B.H.; van der Velde, N.; de Groot, C.P.G.M.

In: Drugs & Aging, Vol. 31, No. 12, 2014, p. 917-927.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study

AU - Ham, A.C.

AU - Swart, K.M.A.

AU - Enneman, A.W.

AU - van Dijk, S.C.

AU - Araghi, S.O.

AU - van Wijngaarden, J.P.

AU - van der Zwaluw, N.L.

AU - Brouwer, E.M.

AU - Dhonukshe-Rutten, R.A.M.

AU - van Schoor, N.M.

AU - van der Cammen, T.J.M.

AU - Lips, P.

AU - Uitterlinden, A.G.

AU - Witkamp, R.F.

AU - Stricker, B.H.

AU - van der Velde, N.

AU - de Groot, C.P.G.M.

N1 - WOS:000345392100007

PY - 2014

Y1 - 2014

N2 - Background Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. Methods Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged >= 65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. Results During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95 % confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95 % CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95 % CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95 % CI 1.02-1.71]), and antidepressant use (HR 1.40 [95 % CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. Conclusion Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.

AB - Background Medication use is a potentially modifiable risk factor for falling; psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk. However, evidence is mainly based on studies that recorded falls retrospectively and/or did not determine medication use at the time of the fall. Therefore, we investigated the associations indicated in the literature between medication use and falls, using prospectively recorded falls and medication use determined at the time of the fall. Methods Data from the B-PROOF (B-vitamins for the prevention of osteoporotic fractures) study were used, concerning community-dwelling elderly aged >= 65 years. We included 2,407 participants with pharmacy dispensing records. During the 2- to 3-year follow-up, participants recorded falls using a fall calendar. Cox proportional hazard models were applied, adjusting for potential confounders including age, sex, health status variables and concomitant medication use. Results During follow-up, 1,147 participants experienced at least one fall. Users of anti-arrhythmic medication had an increased fall risk (hazard ratio [HR] 1.61; 95 % confidence interval [CI] 1.12-2.32) compared with non-users. Similarly, non-selective beta-blocker use was associated with an increased fall risk (HR 1.41 [95 % CI 1.12-1.78]), while statin use was associated with a lower risk (HR 0.81 [95 % CI 0.71-0.94]). Benzodiazepine use (HR 1.32 [95 % CI 1.02-1.71]), and antidepressant use (HR 1.40 [95 % CI 1.07-1.82]) were associated with an increased fall risk. Use of other cardiovascular and psychotropic medication was not associated with fall risk. Conclusion Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics, non-selective beta-blockers, benzodiazepines, and antidepressant medication. Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients.

KW - randomized controlled-trial

KW - risk-increasing drugs

KW - primary-care database

KW - physical performance

KW - ophthalmic timolol

KW - psychotropic-drugs

KW - case-series

KW - people

KW - metaanalysis

KW - community

U2 - 10.1007/s40266-014-0225-x

DO - 10.1007/s40266-014-0225-x

M3 - Article

VL - 31

SP - 917

EP - 927

JO - Drugs & Aging

JF - Drugs & Aging

SN - 1170-229X

IS - 12

ER -

Ham AC, Swart KMA, Enneman AW, van Dijk SC, Araghi SO, van Wijngaarden JP et al. Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study. Drugs & Aging. 2014;31(12):917-927. https://doi.org/10.1007/s40266-014-0225-x