The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on February 4, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(4):492-498; doi:10.1093/gerona/gln043
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Number and Dosage of Central Nervous System Medications on Recurrent Falls in Community Elders: The Health, Aging and Body Composition Study
1 Department of Medicine (Geriatrics), School of Medicine
2 Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pennsylvania
3 Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
4 Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania
5 Royal North Shore Hospital and University of Sydney, New South Wales, Australia
6 North Florida/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, Florida
7 Division of General Internal Medicine, University of California at San Francisco
8 Intramural Research Program, National Institute on Aging, Baltimore, Maryland
Address correspondence to Joseph T. Hanlon, PharmD, MS, Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Kaufman Medical Building, Suite 514, 3471 5th Avenue, Pittsburgh, PA 15213. Email: hanlonj{at}dom.pitt.edu
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Abstract |
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Background: Few studies have examined the risk of multiple or high doses of combined central nervous system (CNS) medication use for recurrent falls in the elderly. The study objective was to evaluate whether multiple- or high-dose CNS medication use in older adults was associated with a higher risk of recurrent (
2) falls.
Methods: This longitudinal cohort study included 3,055 participants from the Health, Aging and Body Composition study who were well functioning at baseline. CNS medication use (benzodiazepine and opioid receptor agonists, antipsychotics, antidepressants) was determined annually (except Year 4) during in-person interviews. The number and summated standard daily doses (SDDs; low, medium, and high) of CNS medications were computed. Falls 1 year later were ascertained annually for 5 years.
Results: For a period of 5 years, as many as 24.1% of CNS medication users took 2+ agents annually, whereas as no more than 18.9% of CNS medication users took high doses annually (3+ SDDs). Yearly, as many as 9.7% of participants reported recurrent falls. Multivariable Generalized Estimating Equation analyses showed that multiple CNS medication users compared with never users had an increased risk of sustaining 2+ falls (adjusted odds ratio [OR] 1.95; 95% confidence interval [CI] 1.35–2.81). Those taking high (3+) CNS SDDs also exhibited an increased risk of 2+ falls (adjusted OR 2.89; 95% CI 1.96–4.25).
Conclusions: Higher total daily doses of CNS medications were associated with recurrent falls. Further studies are needed to determine the impact of reducing the number of CNS medications and/or dosage on recurrent falls.
Keywords Aged; Falls; Central nervous system medications
Received: May 7, 2007; Accepted: September 14, 2008