Medications and Falls – Abstracts

This document contains all abstracts for publications relating to fractures and head injuries from October 2019 through to December 2019. These abstracts have been sourced from and include only those relevant to falls prevention.

SafetyLit provides weekly abstracts of peer reviewed articles from researchers who work in the more than 30 distinct professional disciplines relevant to preventing and researching unintentional injuries, violence, and self-harm. Each week citations and summaries of about 400 articles and reports are included in a PDF document or through an RSS subscription.

Medications Q4 2019

Medications Q1 2020

Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: conditional effect of age
Cordovilla-Guardia S, Molina TB, Franco-Antonio C, Santano-Mogena E, Vilar-López R. PLoS One 2020; 15(1): e0227696.
Andalusian Observatory on Drugs and Addictions, Granada, Spain.
(Copyright © 2020, Public Library of Science)
DOI 10.1371/journal.pone.0227696 PMID 31940406
INTRODUCTION: The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship.

METHOD: From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied.

RESULTS: A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40-2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age.

CONCLUSIONS: The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.
Language: en


The risk of head injuries associated with antipsychotic use among persons with Alzheimer’s disease
Tapiainen V, Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. J. Am. Geriatr. Soc. 2020; ePub(ePub): ePub.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
(Copyright © 2020, John Wiley and Sons)
DOI 10.1111/jgs.16275 PMID 31912482
BACKGROUND/OBJECTIVES: Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer’s disease (AD).

DESIGN: Nationwide register-based cohort study. SETTING: Medication Use and Alzheimer’s Disease (MEDALZ) cohort, Finland. PARTICIPANTS: The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded.

MEASUREMENTS: Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD-10] codes S00-S09) and traumatic brain injuries (TBIs; ICD-10 codes S06.0-S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.

RESULTS: Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person-years = 1.65 [95% confidence interval {CI} = 1.50-1.81] for users and 1.26 [95% CI = 1.16-1.37] for nonusers; IPT-weighted hazard ratio [HR] = 1.29 [95% CI = 1.14-1.47]) and TBIs (event rate per 100 person-years = 0.90 [95% CI = 0.79-1.02] for users and 0.72 [95% CI = 0.65-0.81] for nonusers; IPT-weighted HR = 1.22 [95% CI = 1.03-1.45]). Quetiapine users had higher risk of TBIs (IPT-weighted HR = 1.60 [95% CI = 1.15-2.22]) in comparison to risperidone users.

CONCLUSIONS: These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies.
Language: en

Alzheimer’s disease; antipsychotics; dementia; risk factors; traumatic brain injury