MEDICATION USE AS A RISK FACTOR FOR FALLS IN THE ELDERLY

老年人药物不良反应的风险增加， 轶事证据表明，药物不良反应（ADR）是 不稳定的重要原因，福尔斯和骨折，在这个脆弱的 组 然而，可获得的定量数据很少 关于这种风险的大小，或比较的相对风险， 特定的药物相互作用。 我们建议研究福尔斯和骨折之间的关系， 老年人和以前使用的药物，在五个常见的处方 类别：抗高血压药，利尿剂，苯二氮卓类，抗精神病药， 和抗抑郁药 为了实现这一目标，研究将采用 大规模数据库的计算机辅助流行病学分析： 1980-1984年期间新泽西州的整个医疗补助计划 （N= 900，000）。 所有计划参与者的所有医疗保健交易均 在这个数据集中详细描述，包括大约2000万 35岁以上的收款人的交易。 所有具有任何福尔斯或髋部骨折诊断代码的患者 将确定适当的控制措施。 传统病例对照 然后，将采用方法来识别先前的药物使用 模式，并建立相对风险，根据需要进行控制，以避免混淆 因子和效应修饰符。 这项研究将阐明加速步态不稳的风险， 福尔斯，以及老年患者的相关骨折，因此将奠定一个 可以作为预防工作基础的数据基础。

The elderly are at increased risk of adverse effects from medications, and anecdotal evidence suggests that adverse drug reactions (ADRs) are an important cause of instability, falls and fractures in this vulnerable group. However, there is very little quantitative data available concerning the magnitude of this risk, or comparing the relative risks of specific drugs with one another. We propose to study the relationship between falls and fractures in the elderly and prior use of medications in five commonly prescribed categories: antihypertensives, diuretics, benzodiazepines, neuroleptics, and antidepressants. To accomplish this, the research will employ computer-assisted epidemiological analysis of a large-scale database: the entire Medicaid program of the state of New Jersey for the period 1980-1984 (N=900,000). All health care transactions for all program participants are described in detail in this dataset, comprising some 20 million transactions for recipients over age 35. All patients with any of several diagnostic codes for falls or hip fracture will be identified, as will appropriate controls. Traditional case-control methodologies will then be employed to identify prior medication use patterns and establish relative risk, controlling as needed for confounding factors and effect modifiers. This research will clarify the risk of precipitating gait instability, falls, and associated fractures in elderly patients and will thus lay a foundation of data on which preventive efforts can be built.