Drugs and Falls in Older People: A Systematic Review and Meta-analysis: II. Cardiac and Analgesic Drugs

OBJECTIVES: To evaluate critically the evidence linking specific classes of cardiac and analgesic drugs to falls in older people. DESIGN: Fixed‐effects meta‐analysis. DATA SOURCES: English‐language articles in MEDLINE (1966 – March 1996) indexed under accidents or accidental falls and aged or age factors; bibliographies of retrieved papers. STUDY SELECTION: Systematic evaluation of cardiac or analgesic drug use and any fall in people aged 60 years and older. DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, sample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and nonfallers taking specific classes of cardiac and analgesic drugs. RESULTS: Twenty nine studies met inclusion criteria. None were randomized controlled trials. For one or more falls, the pooled Odds Ratio (95% Confidence Interval) was 1.08 (1.02‐1.16) for diuretic use, 1.06 (0.97‐1.16) for thiazide diuretics, 0.90 (0.73‐1.12) for loop diuretics, 0.93 (0.77‐1.11) for beta‐blockers, 1.16 (0.87‐1.55) for centrally acting antihypertensives, 1.20 (0.92‐1.58) for ACE inhibitors, 0.94 (0.77‐1.14) for calcium channel blockers, 1.13 (0.95‐1.36) for nitrates, 1.59 (1.02‐2.48) for type la antiarrhythmics, and 1.22 (1.05‐1.42) for digoxin use. For analgesic drugs, the pooled OR was 0.97 (0.78‐1.20) for narcotic use, 1.09 (0.88‐1.34) for nonnarcotic analgesic use, 1.16 (0.97‐1.38) for NSAID use, and 1.12 (0.80‐1.57) for aspirin use. There was no statistically significant heterogeneity of pooled odds ratios. There were no differences between the pooled odds ratios for studies with mean subject age