Impact of Discontinuation of Fall-Risk-Increasing Drugs on Falls in Multimorbid Older Patients With Polypharmacy

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2025-04-01 DOI:10.1111/jgs.19460

Namiko A. Goto, Dayna A. M. van Heel, Lauren Dautzenberg, François-Xavier Sibille, Emma Jennings, Douglas C. Bauer, Carole E. Aubert, Anne Spinewine, Nicolas Rodondi, Huiberdina L. Koek, Mariëlle H. Emmelot-Vonk, Wilma Knol

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Abstract

Background

Falls are a major concern in the older population. An important cause of falls is fall-risk-increasing drugs (FRID). However, it is not known if the discontinuation of FRID leads to a reduction of falls. Therefore, the aim of this study was to assess the association between discontinuation of FRID and the occurrence of falls and recurrent falls.

Methods

This study included adults aged ≥ 70 years with multimorbidity and polypharmacy who were enrolled in a cluster randomized controlled trial assessing hospital pharmacotherapy optimization (OPERAM). Participants who were using FRID at baseline, were alive after 2 months of follow-up, and provided data on fall occurrence were included. FRID discontinuation was defined as discontinuation of ≥ 1 FRID within 2 months after inclusion, including the following groups: antidepressants, antiepileptics, antihistamines, antipsychotics, benzodiazepines and z-drugs, diuretics, opioids, and alpha-blockers. Multivariable cox regression analysis, using inverse probability weighting, was performed to assess the association between FRID discontinuation and the occurrence of falls.

Results

Our analysis included 1546 participants, with a median age of 79 years (IQR 74–84) and 45% female. After 2 months of follow-up, FRID were discontinued in 878 (57%) participants. Among all participants, 378 (24%) experienced a fall within 1 year of follow-up, with 137 (9%) of the participants experiencing two or more falls, and 199 (13%) participants experiencing a serious fall. No association was found between FRID discontinuation and the occurrence of falls. In a subgroup of participants with a previous fall, discontinuation of antipsychotics was associated with a lower occurrence of falls (HR 0.32 [CI 0.12–0.84], p = 0.02).

Conclusions

In multimorbid older patients using FRID, falls are highly prevalent. No association was found between discontinuation of FRID and the risk of falls, except for the discontinuation of antipsychotics in patients who experienced a previous fall.

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停用增加跌倒风险的药物对多药并用老年患者跌倒的影响

背景：跌倒是老年人关注的主要问题。导致跌倒的一个重要原因是增加跌倒风险的药物（FRID）。然而，目前尚不清楚停止FRID是否会减少跌倒。因此，本研究的目的是评估停止FRID与跌倒发生和复发性跌倒之间的关系。方法：本研究纳入了年龄≥70岁、患有多种疾病和多种药物的成年人，他们参加了一项评估医院药物治疗优化（OPERAM）的整群随机对照试验。基线时使用FRID的参与者，随访2个月后存活，并提供跌倒发生的数据。FRID停药定义为纳入后2个月内停药≥1次FRID，包括以下组：抗抑郁药、抗癫痫药、抗组胺药、抗精神病药、苯二氮卓类药物和z-药物、利尿剂、阿片类药物和α -受体阻滞剂。采用逆概率加权进行多变量cox回归分析，以评估FRID停药与跌倒发生之间的关系。结果：我们的分析包括1546名参与者，中位年龄为79岁（IQR 74-84），其中45%为女性。随访2个月后，878名（57%）参与者停止了FRID治疗。在所有参与者中，378人（24%）在1年的随访中经历了跌倒，其中137人（9%）经历了两次或两次以上的跌倒，199人（13%）经历了严重的跌倒。没有发现FRID停药与跌倒发生之间的联系。在先前跌倒的参与者亚组中，停用抗精神病药物与跌倒发生率降低相关（HR 0.32 [CI 0.12-0.84], p = 0.02）。结论：在使用FRID的多病老年患者中，跌倒非常普遍。除有跌倒经历的患者停用抗精神病药物外，未发现停用FRID与跌倒风险之间存在关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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