Conclusion: Indications for effectiveness
Withdrawal of psychotropic medication (benzodiazepines, antidepressants, neuroleptics) is effective in reducing falls in elderly. To some lesser degree evidence is found in favor of withdrawal of cardiovascular drugs digoxin, type IA antiarrhythmic, and some of the diuretics.
Recommendations (for research & practice)
Critical evaluation of prescribed medication, considering gradual withdrawal of psychotropic and/or cardiovascular drugs is needed. Randomised trials with sufficient power are needed to investigate the effect of withdrawal of not only different types of psychotropic drugs on falls prevention, but als the effect of withdrawal other fall related drugs.These studies should also look at potential harms by medication withdrawal.
A guideline advice that withdrawal of fall-risk-increasing drugs should be part of the multi-factorial intervention for patients presenting with falls.
Review Date: 05/11/2009
Version: 1.0
Status: Publish
Procedure
First the titles and then abstracts were scanned in order to include relevant studies. Two recent reviews were selected and scrutinised and background documents were created. The resulting evidence statements were subjected to expert review and if necessary adapted.
Background documents
Interventions for preventing falls in older people living in the community (version 1)
L.D. Gillespie, M.C. Robertson, W.J. Gillespie ... [et al.] (2009)
Prevention of falls and consequent injuries in elderly people (version 1)
P. Kannus, H. Sievanen, M. Palvanen ... [et al.] (2005)
Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study (version 1)
N. van der Velde, B.H. Stricker, H.A. Pols, ...[et.al] (2007)
Drugs and falls in older people : a systematic review and meta-analysis: II. cardiac and analgesic drugs (version 1)
Rosanne M. Leipzig, Robert G. Cumming, Mary E. Tinetti (1999)
Drugs and falls in older people : a systematic review and meta-analysis: I. psychotropic drugs (version 1)
Rosanne M. Leipzig, Robert G. Cumming, Mary E. Tinetti (1999)
Polypharmacy and falls in the middle age and elderly population (version 1)
G. Ziere, J.P. Dieleman, A. Hofman ... [et al.] (2006)