Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics

Background and objective: Falls are a major public health problem in older adults. Earlier studies showed that psychotropic medication use increases the risk of falls. The aim of this study is to update the current knowledge by providing a comprehensive systematic review and meta-analysis on psychotropic medication use and falls in older adults. Methods and design: This study is a systematic review and meta-analysis. A search was conducted in Medline, PsycINFO, and Embase. Key search concepts were “falls,” “aged,” “medication,” and “causality.” Studies were included that investigated psychotropics (antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics) as risk factors for falls in participants ≥60 years of age or participants with a mean age of ≥70 years. Meta-analyses were performed using generic inverse variance method pooling unadjusted and adjusted odds ratio (OR) estimates separately. Results: In total, 248 studies met the inclusion criteria for qualitative synthesis. Meta-analyses using adjusted data showed the following pooled ORs: antipsychotics 1.54 [95% confidence interval (CI) 1.28–1.85], antidepressants 1.57 (95% Cl 1.43–1.74), tricyclic antidepressants 1.41 (95% CI 1.07–1.86), selective serotonin reuptake inhibitors 2.02 (95% CI 1.85–2.20), benzodiazepines 1.42 (95%, CI 1.22–1.65), long-acting benzodiazepines 1.81 (95%, CI 1.05–3.16), and short-acting benzodiazepines 1.27 (95%, CI 1.04–1.56) Most of the meta-analyses resulted in substantial heterogeneity that did not disappear after stratification for population and healthcare setting. Conclusions: Antipsychotics, antidepressants, and benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Prescription bias could not be accounted for. Future studies need to address pharmacologic subgroups as fall risk may differ depending on specific medication properties. Precise and uniform classification of target medication (Anatomical Therapeutic Chemical Classification) is essential for valid comparisons between studies. © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine