Abstract：
while many drug groups are associated with falls in older people, less is known about absolute increases in risk and how these risks vary across different groups of drugs or individuals.
we conducted a population based nested case-control study among people aged ≥65 years in the Scottish regions of Tayside and Fife. Cases were individuals hospitalised with a fracture between 2010 and 2020, to whom we matched up to 10 controls. We examined relative and absolute risks of drug groups known as \'Fall-Risk-Increasing Drugs\' (FRIDs), alone and in combination, and among younger and older (≥75 years) adults. Adjusting for previous hospitalisations, drug use and laboratory data, we used conditional logistic regression to quantify associations between drug exposures and outcomes. We conducted four sensitivity analyses to test the robustness of our findings.
the cohort comprised 246,535 people aged ≥65 years, of whom 18,456 suffered an incident fracture. Fracture risks were significantly increased for most FRIDs examined. Absolute risks were much larger among older vs younger people and both relative and absolute risks increased with the number of FRIDs combined. Overall, the highest absolute increase in risk were found in people aged ≥75 years for selective serotonin reuptake inhibitors (number needed to harm 53), tricyclic antidepressants (NNH 81), antipsychotics (NNH 75) and use of three or more FRIDs (NNH ≤66).
patients aged ≥75 years prescribed antidepressants or antipsychotics or taking three or more drugs that increase risk of falls may benefit most from deprescribing interventions.
we conducted a population based nested case-control study among people aged ≥65 years in the Scottish regions of Tayside and Fife. Cases were individuals hospitalised with a fracture between 2010 and 2020, to whom we matched up to 10 controls. We examined relative and absolute risks of drug groups known as \'Fall-Risk-Increasing Drugs\' (FRIDs), alone and in combination, and among younger and older (≥75 years) adults. Adjusting for previous hospitalisations, drug use and laboratory data, we used conditional logistic regression to quantify associations between drug exposures and outcomes. We conducted four sensitivity analyses to test the robustness of our findings.
the cohort comprised 246,535 people aged ≥65 years, of whom 18,456 suffered an incident fracture. Fracture risks were significantly increased for most FRIDs examined. Absolute risks were much larger among older vs younger people and both relative and absolute risks increased with the number of FRIDs combined. Overall, the highest absolute increase in risk were found in people aged ≥75 years for selective serotonin reuptake inhibitors (number needed to harm 53), tricyclic antidepressants (NNH 81), antipsychotics (NNH 75) and use of three or more FRIDs (NNH ≤66).
patients aged ≥75 years prescribed antidepressants or antipsychotics or taking three or more drugs that increase risk of falls may benefit most from deprescribing interventions.
摘要：
背景：虽然许多药物组都与老年人跌倒有关，关于风险的绝对增加以及这些风险在不同药物组或个体之间的差异知之甚少.
方法：我们在Tayside和Fife苏格兰地区65岁以上人群中进行了一项基于人群的巢式病例对照研究。病例是2010年至2020年之间因骨折住院的个体，我们匹配了多达10名对照。我们检查了被称为“跌倒风险增加药物”（FRID）的药物组的相对和绝对风险，单独和组合，以及年轻和年长（≥75岁）的成年人。根据以前的住院情况进行调整，药物使用和实验室数据，我们使用条件逻辑回归量化药物暴露与结局之间的关联.我们进行了四次敏感性分析，以测试我们发现的稳健性。
结果：该队列包括246,535名年龄≥65岁的人，其中18,456人遭受了意外骨折。大多数FRID检查的骨折风险显著增加。老年人与年轻人的绝对风险更大，并且相对和绝对风险随着FRID的合并数量而增加。总的来说,选择性5-羟色胺再摄取抑制剂的年龄≥75岁人群的绝对风险增加最高（伤害所需的人数为53），三环抗抑郁药（NNH81），抗精神病药（NNH75）和使用三种或更多种FRID（NNH≤66）。
结论：年龄≥75岁的患者服用抗抑郁药或抗精神病药或服用增加跌倒风险的三种或更多种药物可能从处方干预措施中获益最大。
方法：我们在Tayside和Fife苏格兰地区65岁以上人群中进行了一项基于人群的巢式病例对照研究。病例是2010年至2020年之间因骨折住院的个体，我们匹配了多达10名对照。我们检查了被称为“跌倒风险增加药物”（FRID）的药物组的相对和绝对风险，单独和组合，以及年轻和年长（≥75岁）的成年人。根据以前的住院情况进行调整，药物使用和实验室数据，我们使用条件逻辑回归量化药物暴露与结局之间的关联.我们进行了四次敏感性分析，以测试我们发现的稳健性。
结果：该队列包括246,535名年龄≥65岁的人，其中18,456人遭受了意外骨折。大多数FRID检查的骨折风险显著增加。老年人与年轻人的绝对风险更大，并且相对和绝对风险随着FRID的合并数量而增加。总的来说,选择性5-羟色胺再摄取抑制剂的年龄≥75岁人群的绝对风险增加最高（伤害所需的人数为53），三环抗抑郁药（NNH81），抗精神病药（NNH75）和使用三种或更多种FRID（NNH≤66）。
结论：年龄≥75岁的患者服用抗抑郁药或抗精神病药或服用增加跌倒风险的三种或更多种药物可能从处方干预措施中获益最大。
