Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Abstract

ObjectiveTo investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults.MethodsWe performed a nationwide matched (age, sex, and case event day) case–control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co‐morbidity index, dementia and number of other drugs.ResultsAntidepressants were the psychotropic most strongly related to fall injuries (ORadjusted: 1.42; 95% CI: 1.38–1.45) and antipsychotics to hospitalizations (ORadjusted: 1.22; 95% CI: 1.19–1.24) and death (ORadjusted: 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: ORadjusted: 1.53; 95% CI: 1.39–1.68), hospitalization (4 psychotropics vs 0: ORadjusted: 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: ORadjusted: 2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n = 58,984), a dose–response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: ORadjusted: 1.99; 95% CI: 1.76–2.25).ConclusionsOur findings support a cautious prescribing of multiple psychotropic drugs to older patients. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.

Association of psychotropic drug use with falls among older adults in Germany. Results of the German Health Interview and Examination Survey for Adults 2008 – 2011 (DEGS1)

“…Surprisingly, we did not find an association of falls or recurrent falls with the use of hypnotics and sedatives, antiepileptics, or narcotic analgesics. However, some studies also found no significant association between falls and the use of anxiolytics/hypnotics [46], or a weaker association with the use of hypnotics and sedatives [45] or antiepilepitcs [47]. In contrast, other studies report positive associations between falls and the use hypnotics and sedatives [12,14,47,48], opioids/narcotics [46,48] [49] or antiepileptics [46].…”

Fall-related mortality in southern Sweden: a multiple cause of death analysis, 1998–2014

“…Diseases of nervous system including Parkinson’s and Alzheimer’s disease are associated with cognitive impairment, visual impairment, freezing in gait, postural instability, muscle weakness and impaired balance which can lead to fall 28 29. In addition, psychotropic drugs used for treating mental disorders might increase risk of fall 30. The negative associations with dementia, diabetes and cardiovascular disorders are in contrast with expectations possibly due to cause of death coding practices.…”

Rise in mortality involving poisoning by medicaments other than narcotics, including poisoning by psychotropic drugs in different age/racial groups in the US

“…In particular, there are major differences in the rates of consumption of antibiotics [11,12], psychotropic drugs [13], including antidepressants [14,15], and sedative-hypnotic medications [16][17][18] between white Americans and other racial groups in the US except Native Americans. A number of studies, including meta-analyses, suggest elevated risks for mortality, including sudden cardiac death (SCD) associated with the use of various psychotropic drugs (both antipsychotics and antidepressants), as well as certain sedative-hypnotic drugs (benzodiazepines) [19][20][21][22][23][24], though firmly establishing causal links in such studies can be challenging [25]. For the case of antibiotics, recent work suggests an association between prescribing rates for certain antibiotics, particularly penicillins in the elderly, and mortality and hospitalization rates for sepsis/septicemia [26,27], with that association presumably being mediated by antimicrobial resistance [28].…”