Risk Of Falls Among Elderly No Better With Atypical Antipsychotics Than Older Agents
The atypical antipsychotic risperidone is no better than typical antipsychotics in terms of the risk of falls in residents of aged care facilities, and the atypical antipsychotic olanzapine may increase the risk of falls, according to findings published in the August issue of the Journal of the American Geriatrics Society.
"Antipsychotic drugs are used to control behavioral symptoms in people with dementia," Dr. Robert G. Cumming told Reuters Health. "Unfortunately, the traditional antipsychotics have many side effects, including causing falls." The new generation of atypical antipsychotics, he noted, are effective in controlling behavioral symptoms of dementia and have fewer side effects than the older drugs.
In a prospective cohort study, Dr. Cumming and colleagues studied 2005 residents of aged care facilities (mean age 86 years). The researchers used medical records to ascertain medication use at baseline. Data on confounders were collected during interviews and physical examinations and from medical records. The main outcome was accidental falls during the first month after baseline.
A total of 1107 subjects (55%) used at least one type of psychotropic medication, and 289 (14%) used an antipsychotic. Of these 289 subjects, 181 were typical antipsychotic users, 82 were olanzapine users, and 38 were risperidone users.
Overall, 226 subjects (11%) had at least one fall during the first month. After adjusting for the use of other psychotropic medications and other risk factors for falls, the hazard ratio (HR) for risperidone users and for typical antipsychotic users was not statistically significant. For olanzapine users, the risk of falls was 1.74 (95% CI 1.04 - 2.90). An association was observed between antidepressants and falls (HR = 1.45; 95% CI 1.09 - 1.93)
"In older people with dementia, physicians need to balance the benefits of antipsychotics (in terms of symptom reduction) against the risks (including risk of falling)," Dr. Cumming said. "More generally, the study adds to the evidence that all psychoactive medications (sleeping pills, sedatives, anxiolytics, antidepressants, and antipsychotics) can cause falls in older people -- yet another reason to use these drugs with great care."
J Am Geriatr Soc 2005;53:1290-1295.
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