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 Fall-risk-increasing drugs were withdrawn, if possible.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.

译文

目的:老年人摔倒是一个经常且严重的临床问题。几种药物与跌倒风险增加有关。这项研究的目的是确定增加跌倒风险的药物停药(停药或减少剂量)后跌倒发生率的差异,作为对老年跌倒者的单一干预措施。
方法:在一项针对老年门诊患者的前瞻性队列研究中,我们纳入了139名在上一年中出现一次或多次跌倒的患者。如果可能的话,撤回增加秋天风险的药物。在设定的1个月停药期后的2个月内进行随访,评估跌倒的发生率。使用Cox比例风险模型对潜在混杂因素进行了多变量调整。
结果:在67例患者中,我们能够终止增加跌倒风险的药物,在8例患者中降低了剂量。在这75名患者中,随访期间跌倒的总次数明显少于继续治疗的患者(跌倒的平均次数:0.3 vs. 3.6; P值0.025)。随访期间跌倒的风险比为:整体戒断为0.48(95%置信区间(CI)0.23,0.99),心血管戒断为0.35(95%CI 0.15,0.82)和0.56(95%CI 0.23, 1.38)对于精神药物戒断,在调整年龄,性别,使用增加跌倒风险的药物,基线跌倒频率,合并症,小精神状态检查得分和转诊原因后进行调整。
结论:在老年门诊患者中,降低跌倒风险的药物作为预防跌倒的单一干预措施似乎是有效的。对于戒断心血管药物效果最大。

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