Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study

Authors

  • Nathalie Van Der Velde,

    1. Department of Internal Medicine, Erasmus University Medical Center,
    2. Section of Geriatric Medicine, Erasmus University Medical Center and
    3. Department of Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Bruno H. Ch. Stricker,

    1. Department of Internal Medicine, Erasmus University Medical Center,
    2. Department of Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Huib A. P. Pols,

    1. Department of Internal Medicine, Erasmus University Medical Center,
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  • Tischa J. M. Van Der Cammen

    Corresponding author
    1. Department of Internal Medicine, Erasmus University Medical Center,
    2. Section of Geriatric Medicine, Erasmus University Medical Center and
      Tischa J.M. van der Cammen, MD PhD, Head Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Room D442, PO Box 2040, 3000-CA Rotterdam, the Netherlands.
      Tel: + 31 10463 5979
      Fax: + 31 10463 4768
      E-mail: t.vandercammen@erasmusmc.nl
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Tischa J.M. van der Cammen, MD PhD, Head Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Room D442, PO Box 2040, 3000-CA Rotterdam, the Netherlands.
Tel: + 31 10463 5979
Fax: + 31 10463 4768
E-mail: t.vandercammen@erasmusmc.nl

Abstract

What is already known about this subject

• In observational studies, several drugs have been associated with an increased fall risk. A meta-analysis in 1999 found a significant association for neuroleptics, antidepressants, sedatives, diuretics, type IA antiarrhythmics, and digoxin.

• Nevertheless, knowledge on the effect of withdrawal of these drugs on fall risk is scarce. Only one randomized controlled trial has been carried out in 1999, showing a significantly lowered fall risk after withdrawal of sedatives and antidepressants in community-dwelling older persons.

What this study adds

• This study indicates that withdrawal of all fall-risk-increasing drugs, including both cardiovascular and psychotropic drugs, is an effective intervention for lowering of falls incidence. This effect appears to be highest for withdrawal of cardiovascular drugs.

Aims

Falling in older persons is a frequent and serious clinical problem. Several drugs have been associated with increased fall risk. The objective of this study was to identify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall-risk-increasing drugs as a single intervention in older fallers.

Methods

In a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall-risk-increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow-up after a set 1 month period of drug withdrawal. Multivariate adjustment for potential confounders was performed with a Cox proportional hazards model.

Results

In 67 patients, we were able to discontinue a fall-risk-increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow-up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow-up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall-risk-increasing drugs, baseline falls frequency, comorbidity, Mini-Mental State Examination score, and reason for referral.

Conclusions

Withdrawal of fall-risk-increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs.

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