MEDICATION USE AS A RISK FACTOR FOR FALLS IN THE ELDERLY

老年人服用药物产生不良反应的风险增加， 坊间证据表明，药物不良反应(ADR)是一种 这是导致不稳定、跌倒和骨折的重要原因 一群人。然而，可用的量化数据非常少。 关于这种风险的大小，或者比较 特定的药物相互联系。 我们建议研究跌倒和骨折之间的关系。 老年人和既往使用药物的五种常用处方 类别：抗高血压药、利尿剂、苯二氮卓类、抗神经药、 还有抗抑郁药。为了实现这一点，该研究将采用 大型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为 在此数据集中详细描述，包括约2000万 针对35岁以上收件人的交易。 所有有跌倒或髋部骨折诊断代码的患者 将被确定，以及适当的控制措施。传统病例对照 然后，将采用方法学来确定以前的用药情况 模式并建立相对风险，根据需要进行控制以进行混淆 因子和效果修饰符。 这项研究将阐明导致步态不稳定的风险， 在老年患者中发生跌倒和相关骨折，因此将为 数据基础，可以在此基础上开展预防工作。

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.