One randomised controlled trial (RCT, 537 participants) and 28 observational studies (12 prospective and 7 retrospective cohort studies and 9 case-control studies; 191,458 participants) were included in the review.
In the RCT, treatment groups were comparable at baseline and the analysis controlled for the degree of wandering behaviour and use of other psychotropic drugs. Observational studies adjusted for a variety of confounders: age (23 studies), gender (23 studies that only included women), chronic condition (21 studies), cognitive status (14 studies), physical performance (10 studies) and use of other medications (14 studies).
There were discrepancies between the results reported in the table and text; the results below have been taken from the text of the review.
Psychotropic and other CNS drugs (27 studies): Benzodiazepines (20 studies): 17 studies reported an association between falls/fall-related fractures and benzodiazepines. Antidepressants including tricyclics and selective serotonin re-uptake inhibitors (17 studies): 12 studies reported an association between falls/fall-related fractures and antidepressants. Antipsychotics (9 studies): 6 studies reported an association between falls/fall-related fractures and antipsychotics. The only study of new atypical antipsychotics reported no association. The RCT reported a dose-dependent association, with risperidone 2 mg/day increasing the risk of falls but not a dose of 1 mg/day.Antiepileptics (4 studies): 3 studies reported an association between falls/fall-related fractures and antiepileptics.Cholinesterase inhibitors (1 study): this study reported no association between falls/fall-related fractures and cholinesterase inhibitors. Opioids (2 studies): 1 study reported an association between falls/fall-related fractures and opioids.
Other medications (12 studies):Three studies reported an association between falls/fall-related fractures and cardiovascular drugs (these studies evaluated antihypertensive drugs).
Polypharmacy: It was unclear how many studies assessed the effects of multiple drugs. Three studies reported that the risk of falling increased with the number of drugs.