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.

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Objectives To evaluate whether combined use of multiple central nervous system (CNS) medications over time is associated with cognitive change. Design Longitudinal cohort study. Setting Pittsburgh, PA and Memphis, TN. Participants 2737 healthy adults (aged ≥ 65) enrolled in the Health, Aging and Body Composition study without baseline cognitive impairment (modified Mini-Mental Status [3MS] score >80). Measurements CNS medication (benzodiazepine and opioid receptor agonists, antipsychotics, antidepressants) use, duration, and dose were determined at baseline (year 1) and years 3 and 5. Cognitive function was measured with the 3MS at baseline, years 3 and 5. The outcome variables were incident cognitive impairment (3MS score< 80) and cognitive decline (≥5 point decline on 3MS). Multivariable interval-censored survival analyses were conducted. Results By year 5, 7.7% had incident cognitive impairment; 25.2% demonstrated cognitive decline. CNS medication use increased from 13.9% at baseline to 15.3% and 17.1% at years 3 and 5, respectively. It was not associated with incident cognitive impairment (Adjusted Hazard Ratio [Adj. HR] 1.11; 95% Confidence Interval [CI] 0.73–1.69) but was associated with cognitive decline (Adj. HR 1.37; 95% CI 1.11–1.70). Compared to non-use, longer duration (Adj. HR 1.39, CI=1.08–1.79) and higher doses (> 3 standardized daily doses) (Adj. HR 1.87; 95% CI 1.25–2.79) of CNS medications suggested greater risk of cognitive decline. Conclusion Combined use of CNS medications, especially at higher doses, appears to be associated with cognitive decline in older adults. Future studies must explore the effect of combined CNS medication use on vulnerable older adults.

Background-Medication underutilization, or the omission of a potentially beneficial medication indicated for disease management, is common among older adults but poorly understood.

SUMMARY Purpose To evaluate whether CNS medication use in older adults was associated with a higher risk of future incident mobility limitation. Methods This 5-year longitudinal cohort study included 3055 participants from the health, aging and body composition (Health ABC) study who were well-functioning at baseline. CNS medication use (benzodiazepine and opioid receptor agonists, antipsychotics, and antidepressants) was determined yearly (except year 4) during in-home or in-clinic interviews. Summated standardized daily doses (low, medium, and high) and duration of CNS drug use were computed. Incident mobility limitation was operationalized as two consecutive self-reports of having any difficulty walking 1/4 mile or climbing 10 steps without resting every 6 months after baseline. Multivariable Cox proportional hazard analyses were conducted adjusting for demographics, health behaviors, health status, and common indications for CNS medications. Results Each year at least 13.9% of participants used a CNS medication. By year 6, overall 49% had developed incident mobility limitation. In multivariable models, CNS medication users compared to never users showed a higher risk for incident mobility limitation (adjusted hazard ratio (Adj. HR) 1.28; 95% confidence interval (CI) 1.12–1.47). Similar findings of increased risk were seen in analyses examining dose– and duration–response relationships. Conclusions CNS medication use is independently associated with an increased risk of future incident mobility limitation in community dwelling elderly. Further studies are needed to determine the impact of reducing CNS medication exposure on mobility problems.