BMJ  2003;327:1288 (29 November), doi:10.1136/bmj.327.7426.1288

Letter

Falls, chronic diseases, and drug use in elderly women

Lack of association may be explained

EDITOR—In a cross sectional study reported by Lawlor et al use of cardiovascular drugs was not independently associated with a fall.¹ The authors have not, however, addressed certain issues concerning prescribing patterns of these drugs that may have influenced this result.

Appropriate prescription of cardiovascular drugs—for example, angiotensin converting enzyme (ACE) inhibitors—may present with difficulties. ACE inhibitors improve prognosis of patients with heart failure,² yet a doctor may decide to exercise caution in prescribing these drugs to patients with an increased risk of falls because of, for example, aortic stenosis or symptomatic postural hypotension. Other patients are inappropriately deprived of ACE inhibitors because of older age³ or unfounded concerns about adverse effects.⁴ A similar pattern may exist for other cardiovascular drugs—for example, calcium channel blockers or nitrates.

A significant proportion of patients in this study that were at risk of falls may not have been prescribed cardiovascular drugs, appropriately or inappropriately, by their medical practitioner. This may explain the lack of association between falls and cardiovascular drugs reported in this study.

The result of this study should not distract from the issue that patients at risk of falls should be prescribed cardiovascular drugs after careful consideration of other factors such as concomitant medical conditions and drug treatment. A comprehensive geriatric assessment in a falls clinic may be able to provide optimal treatment in these situations.

University Hospital of North Staffordshire, Stoke on Trent, Staffordshire ST4 6QG elliotepstein832{at}hotmail.com

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Competing interests: None declared.

References

1. Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 2003;327: 712-7. (27 September.)[Abstract/Free Full Text]
2. SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular function and congestive heart failure. N Engl J Med 1991;325: 293-302[Abstract]
3. Echemann M, Zannad F, Briancon S, Juilliere Y, Mertes PM, Virion JM, et al. Determinants of angiotensin-converting enzyme inhibitor prescription in severe heart failure with left ventricular systolic dysfunction: the EPICAL study. Am Heart J 2000;139: 624-31.[ISI][Medline]
4. Large State Peer Review Organization Consortium. Heart failure treatment with angiotensin-converting enzyme inhibitors in hospitalized Medicare patients in 10 large states. Arch Intern Med 1997;157: 1103-8.[Abstract]

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Association between falls in elderly women and chronic diseases and drug use: cross sectional study

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