Falls, chronic diseases, and drug use in elderly womenBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7426.1288 (Published 27 November 2003) Cite this as: BMJ 2003;327:1288
Lack of association may be explained
- Elliot F Epstein, specialist registrar in general and geriatric medicine ()
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.
Competing interests None declared.