NSAIDs and the risk of accidental falls in the elderly: a systematic review

Accidental falls, especially those occurring in the elderly, are a major health and research topic nowadays. Besides environmental hazards and the physiological changes associated with aging, medication use (e.g. benzodiazepines, vasodilators and antidepressants) and polypharmacy are significant risk factors for falling as well. Exposure to NSAIDs has been associated with accidental falls too, although information on this area is less consistent. Therefore, the main goal of this review is to provide an updated overview of all the evidence published on the risk of falling due to NSAID use thus far. A systematic literature search for material published between 1966 and March 2008 in PubMed, EMBASE, the Cochrane Database of Systematic Reviews, Exerpta Medica, Current Contents and Science Citation Index was combined with a check of the reference lists of all the retrieved articles. Validity and data extraction of the eligible articles was assessed by adapted criteria, based on checklists that were originally developed to assess case-control or cohort studies. From the 16 selected articles, two studies were rejected because of clustering of data and one article was excluded because it contained the same data as that in one of the included articles. None of the articles retrieved included a randomized controlled trial. The remaining 13 studies all showed some lack in completeness of their statistical methods, and much variation in reporting of effects. The overall mean age was high in the study populations, leaving the results to be poorly generalizable to a larger population and other age categories. Despite these imperfections, all studies showed an increased risk of falling due to NSAID use (four significant, nine non-significant), and a tendency towards an increased fall risk with NSAID exposure could be noted. The results shown in the present review suggest that an increased risk for accidental falls is probable when elderly individuals are exposed to NSAIDs. The studies with the highest quality show that the community-dwelling elderly in particular appear to be at higher risk. This review can serve as a comprehensive overview of the published evidence on fall risk of elderly individuals attributable to the use of NSAIDs, and as an inducement for future research.