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Learning Objective 1: Compare the risk for falls for older adults taking atypical and conventional antipsychotic drugs.
Learning Objective 2: Evaluate the evidence base for current policies and guidelines concerning medication-related falls.
Background: Guidelines and policy in the U.S. and internationally are based on studies that do not adequately reflect recently marketed drugs including atypical antipsychotic agents, selective serotonin reuptake inhibitor (SSRI) antidepressants, and newer GABA-agonist hypnotic agents. While it was postulated that newer agents do not increase falls, recent meta-analyses show that SSRI do increase fall risk. There are insufficient studies of the newer hypnotic agents to conduct a meta-analysis. While antipsychotic drugs are reputed to be the highest risk category of psychotropics, there has been no meta-analysis comparing conventional and newer atypical antipsychotic agents. In addition, falls resulting in injury are the true target of fall prevention. Therefore, this meta-analysis focused on the association of conventional and atypical antipsychotic drugs with hip fracture, a common and debilitating fall-related injury.
Methods: A search of Pubmed/Medline was conducted from 1966-2010 with key words including [antipsychotic agents; psychotropic drugs; or atypical antipsychotic drugs] and [age factor; aged] and [hip fracture; fractures, bone/etiology or fractures, bone/chemically induced]. Inclusion criteria included comparison of drug exposed fallers and non-fallers; mean age > 65 years, and statistical adjustment or stratification or age and gender. Excluded were studies where hip fractures were not distinguished from other fracture types, adjusted odds ratios were not reported, or failure of authors to answer queries for required information.
Results/Conclusions: Of 121 studies identified, only four studies totaling 51,470 subjects from multiple nations met inclusion criteria. Preliminary odds ratio for conventional antipsychotic drugs is 1.66 (95% CI: 1.39, 1.98); for the atypical antipsychotic drugs odds ratio is 1.29 (95% CI: 1.12, 1.48). Both classes increase risk of hip fracture in older adults. Implications for updating policy and guidelines are considered.
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