Psychotropic medications, including short acting benzodiazepines, strongly increase the frequency of falls in elderly

Abstract

Objectives

Falls in the elderly are common and often serious. The aim of this study was to examine the association between the use of different classes of psychotropic medications, especially short acting benzodiazepines, and the frequency of falling in elderly.

Study design This retrospective cohort study was performed with patients who visited the day clinic of the department of geriatric medicine of the University Medical Center Utrecht in the Netherlands between 1 January 2011 and 1 April 2012.

Measurements Frequencies of falling in the past year and medication use were recorded. Logistic regression analysis was performed to assess the relationship between the frequency of falling in the past year and the use of psychotropic medications.

Results

During this period 404 patients were included and 238 (58.9%) of them had experienced one or more falls in the past year. After multivariate adjustment, frequent falls remained significantly associated with exposure to psychotropic medications (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.17–3.28), antipsychotics (OR 3.62; 95% CI 1.27–10.33), hypnotics and anxiolytics (OR 1.81; 95% CI 1.05–3.11), short-acting benzodiazepines or Z-drugs (OR 1.94; 95% CI 1.10–3.42) and antidepressants (OR 2.35; 95% CI 1.33–4.16).

Conclusions

This study confirms that taking psychotropic medication, including short-acting benzodiazepines, strongly increases the frequency of falls in elderly. This relation should be explicitly recognized by doctors prescribing for older people, and by older people themselves. If possible such medication should be avoided for elderly patients especially with other risk factors for falling.

Introduction

The World Health Organization describes a fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” [1]. Approximately 28–35% of people aged 65 and over fall each year, increasing to 32–42% for those over 70 years of age. Approximately 30–50% of people living in long term care institutions fall each year and 40% of them experience recurrent falls [1]. Falls constitute a leading cause of injuries, hospitalisation and deaths among the elderly [2]. The annual costs associated with falls and fall-related complications are substantial [3]. The costs related to fall injuries are expected to rise steeply over the next 50 years as a result of the increase in the elderly population [4]. Fall risk is multifactorial, with many intrinsic and extrinsic factors. Prescribed medications are an important contributor to falls in seniors [5]. In a meta-analysis that included studies between 1966 and 1996, Leipzig et al. found an association between the use of most classes of psychotropic drugs, cardiac and analgesic drugs and falls [6], [7]. The general message that psychotropic drugs increase falls is already well accepted. However, the contribution of specific psychotropic drugs to fall frequency in elderly has not been quantified precisely until now. The older patient is more frail than normal adults and thus more prone to the negative effects of psychotropic drugs. Furthermore, results from different studies are inconsistent concerning benzodiazepines, as short- or intermediate-acting benzodiazepines were not always associated with an increased frequency of falling [8], [9], [10]. The aim of the current study was to evaluate the association between the use of different classes of psychotropic drugs, especially short acting benzodiazepines, and the frequency of falling in elderly patients who visited the day clinic of the department of geriatric medicine of the University Medical Center Utrecht.