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Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs

2018; Elsevier BV; Volume: 19; Issue: 4 Linguagem: Inglês

10.1016/j.jamda.2017.12.013

1538-9375

Max de Vries, Lotta J. Seppälä, Joost G. Daams, Esther M.M. van de Glind, Tahir Masud, Nathalie van der Velde, Hubert Blain, Jean Bousquet, Gösta Bucht, María Ángeles Caballero-Mora, Tischa van der Cammen, Patrik Eklund, Mariëlle H. Emmelot‐Vonk, Yngve Gustafson, Sirpa Hartikainen, Rose Anne Kenny, Lucie Laflamme, Francesco Landi, Tahir Masud, Irene O’Byrne-Maguire, Mirko Petrović, Leocadio Rodriguez, Lotta J. Seppälä, Olle Svensson, Katarzyna Szczerbińska, H Thaler, Nathalie van der Velde,

Blood Pressure and Hypertension Studies

Background and objective Use of certain medications is recognized as a major and modifiable risk factor for falls. Although the literature on psychotropic drugs is compelling, the literature on cardiovascular drugs as potential fall-risk-increasing drugs is conflicting. The aim of this systematic review and meta-analysis is to provide a comprehensive overview of the associations between cardiovascular medications and fall risk in older adults. Methods Design: A systematic review and meta-analysis. Data sources: Medline, Embase, and PsycINFO. Key search concepts were “fall,” “aged,” “causality,” and “medication.” Studies that investigated cardiovascular medications as risk factors for falls in participants ≥60 years old or participants with a mean age of 70 or older were included. A meta-analysis was performed using the generic inverse variance method, pooling unadjusted and adjusted odds ratios (ORs) separately. Results In total, 131 studies were included in the qualitative synthesis. Meta-analysis using adjusted ORs showed significant results (pooled OR [95% confidence interval]) for loop diuretics, OR 1.36 (1.17, 1.57), and beta-blocking agents, OR 0.88 (0.80, 0.97). Meta-analysis using unadjusted ORs showed significant results for digitalis, OR 1.60 (1.08, 2.36); digoxin, OR 2.06 (1.56, 2.74); and statins, OR 0.80 (0.65, 0.98). Most of the meta-analyses resulted in substantial heterogeneity that mostly did not disappear after stratification for population and setting. In a descriptive synthesis, consistent associations were not observed. Conclusion Loop diuretics were significantly associated with increased fall risk, whereas beta-blockers were significantly associated with decreased fall risk. Digitalis and digoxin may increase the risk of falling, and statins may reduce it. For the majority of cardiovascular medication groups, outcomes were inconsistent. Furthermore, recent studies indicate that specific drug properties, such as selectivity of beta-blockers, may affect fall risk, and drug-disease interaction also may play a role. Thus, studies addressing these issues are warranted to obtain a better understanding of drug-related falls.