Separate studies published this week have found evidence for several factors that increase the risk of falls in elderly people.
Falls and their complications are the fifth-leading cause of death in the developed world and researchers have set out to quantify the increase in risk of falling that is associated with different medications and with chronic musculoskeletal pain.
The first paper, published in the 23 November issue of Archives of Internal Medicine, was a meta-analysis of 22 studies that had examined the effect of medicines on risk of falling. The studies included 79,081 participants older than 60 years.
The authors examined the effect on fall risk of nine drug classes: antihypertensive agents, diuretics, beta-blockers, sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, narcotics and non-steroidal anti-inflammatory drugs.
When the results of the studies were pooled and adjusted for other factors, the use of sedatives and hypnotics, antidepressants and benzodiazepines were all significantly associated with the risk of falling in older adults.
The authors say: “The results of our meta-analysis reiterate the need for caution when prescribing these medications to seniors. It is hoped that further research in this area … [will] improve the quality of information about fall risks that is available to physicians and pharmacists when they are deciding which types of pharmacotherapy to provide.”
Arch Intern Med. 2009; 169[21]: 1952-60.
The second paper is a cohort study, published in the Journal of the American Medical Association, in which 749 adults older than 70 years were interviewed about their health, including questions about pain, and had a physical assessment. They kept a monthly record of falls, and more than half of the participants (55%) fell at least once during 18 months’ follow up.
People who reported severe or very severe pain for any given month had a 77% increased risk in falling over the subsequent month than people who had reported no pain. Even people who experienced very mild pain were more likely to fall than those with no pain. Participants who experienced chronic pain in two or more joints had a 50% greater risk of falling compared with those who had no pain.
The authors suggest several possible explanations for the increased falls risk in people with chronic pain, such as muscle weakness, gait disturbance, or pain interfering in the cognitive activity to prevent a fall. They conclude: “The significance of this work is in the identification of chronic pain as an overlooked and potentially important risk factor for falls in older adults,” and ask for further research into whether pain control would reduce fall risk.
JAMA 2009; 302[20]: 2214-21.
