Re: Death by medicine

Risk of falls after withdrawal of fall-risk-increasing drugs: a
prospective cohort study

Nathalie van der Velde,1,2,31Department of Internal Medicine, Erasmus
University Medical Center, 2Section of Geriatric Medicine, Erasmus
University Medical Center and3Department of Epidemiology &
Biostatistics, Erasmus University Medical Center, Rotterdam, the
Netherlands Bruno H. Ch. Stricker,1,31Department of Internal Medicine,
Erasmus University Medical Center, 3Department of Epidemiology &
Biostatistics, Erasmus University Medical Center, Rotterdam, the
Netherlands Huib A. P. Pols 11Department of Internal Medicine, Erasmus
University Medical Center, & Tischa J. M. van der Cammen1,21Department
of Internal Medicine, Erasmus University Medical Center, 2Section of
Geriatric Medicine, Erasmus University Medical Center andTischa J.M.
van der Cammen, MD PhD, Head Section of Geriatric Medicine, Department
of Internal Medicine, Erasmus University Medical Center, Room D442, PO
Box 2040, 3000-CA Rotterdam, the Netherlands.
Tel: + 31 10463 5979
Fax: + 31 10463 4768
E-mail: t.vandercammen@xxxxxxxxxxxx 1Department of Internal Medicine,
Erasmus University Medical Center, 2Section of Geriatric Medicine,
Erasmus University Medical Center and3Department of Epidemiology &
Biostatistics, Erasmus University Medical Center, Rotterdam, the
Netherlands
Tischa J.M. van der Cammen, MD PhD, Head Section of Geriatric
Medicine, Department of Internal Medicine, Erasmus University Medical
Center, Room D442, PO Box 2040, 3000-CA Rotterdam, the Netherlands.
Tel: + 31 10463 5979
Fax: + 31 10463 4768
E-mail: t.vandercammen@xxxxxxxxxxxx

Abstract
What is already known about this subject

· In observational studies, several drugs have been associated with an
increased fall risk. A meta-analysis in 1999 found a significant
association for neuroleptics, antidepressants, sedatives, diuretics,
type IA antiarrhythmics, and digoxin.

· Nevertheless, knowledge on the effect of withdrawal of these drugs
on fall risk is scarce. Only one randomized controlled trial has been
carried out in 1999, showing a significantly lowered fall risk after
withdrawal of sedatives and antidepressants in community-dwelling
older persons.

What this study adds

· This study indicates that withdrawal of all fall-risk-increasing
drugs, including both cardiovascular and psychotropic drugs, is an
effective intervention for lowering of falls incidence. This effect
appears to be highest for withdrawal of cardiovascular drugs.

Aims
Falling in older persons is a frequent and serious clinical problem.
Several drugs have been associated with increased fall risk. The
objective of this study was to identify differences in the incidence
of falls after withdrawal (discontinuation or dose reduction) of fall-
risk-increasing drugs as a single intervention in older fallers.

Methods
In a prospective cohort study of geriatric outpatients, we included
139 patients presenting with one or more falls during the previous
year. Fall-risk-increasing drugs were withdrawn, if possible. The
incidence of falls was assessed within 2 months of follow-up after a
set 1 month period of drug withdrawal. Multivariate adjustment for
potential confounders was performed with a Cox proportional hazards
model.

Results
In 67 patients, we were able to discontinue a fall-risk-increasing
drug, and in eight patients to reduce its dose. The total number of
fall incidents during follow-up was significantly lower in these 75
patients, than in those who continued treatment (mean number of falls:
0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow-
up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug
withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug
withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug
withdrawal, after adjustment for age, gender, use of fall-risk-
increasing drugs, baseline falls frequency, comorbidity, Mini-Mental
State Examination score, and reason for referral.

Conclusions
Withdrawal of fall-risk-increasing drugs appears to be effective as a
single intervention for falls prevention in a geriatric outpatient
setting. The effect was greatest for withdrawal of cardiovascular
drugs.

* * *
I thought this was kind of interesting.

Marilyn

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