Number and Dosage of Central Nervous System Medications on Recurrent Falls in Community Elders

The Health, Aging and Body Composition Study

Hanlon, Joseph T.
Boudreau, Robert M.
Roumani, Yazan F.
Newman, Anne B.
Ruby, Christine M.
Wright, Rollin M.
Hilmer, Sarah N.
Shorr, Ronald I.
Bauer, Douglas C.
Simonsick, Eleanor M.
Studenski, Stephanie A.

¹Department of Medicine (Geriatrics), School of Medicine, University of Pittsburgh, Pennsylvania
²Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pennsylvania
³Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pennsylvania
⁴Department of Epidemiology, School of Public Health, University of Pittsburgh, Pennsylvania
⁵Royal North Shore Hospital and University of Sydney, New South Wales, Australia
⁶North Florida/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, Florida
⁷Division of General Internal Medicine, University of California at San Francisco
⁸Intramural 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: [email protected]

Received May 7, 2007; Accepted September 14, 2008

Decision Editor: Luigi Ferrucci, MD, PhD

Journals of Gerontology Series A: Biological Sciences and Medical Sciences 64A(4):p 492-498, April 2009.

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.