Drogas y las caídas en personas mayores: una revisión sistemática y meta-análisis. I. drogas psicotrópicas

CRD COMMENTARY:

The aims and inclusion criteria are clearly stated. Details are given of methods used to select primary studies and extract data. Validity and heterogeneity were assessed and investigation of heterogeneity was undertaken. Results are presented in graphical format. The discussion includes consideration of the following factors: use of a search strategy that would not have retrieved any randomised controlled trials that evaluated falls as one of many adverse outcomes; the weak evidence of causal association provided by observational studies; likelihood of publication bias; overestimate of risk due to use of OR rather than RR because of OR being the only effect size calculable for all studies; inability to assess confounding by indication due to lack of evaluation of mental impairment in any study close to the time of the fall; data being collected over a twenty year period during which time new psychotropic agents were introduced, changes made in dosage recommendations and indications, plus a heightened awareness of the potential hazards associated with use of these medications in older people; inability to examine the effect of dosage due to lack of available data; lack of differentiation in the primary studies between injurious and non- injurious injuries; and use of variable definitions and ascertainment of fall injuries.
By limiting the literature search to published studies in the English language, some relevant studies may have been omitted. No details were given of the statistical tests used to assess heterogeneity or factors for which adjustments were made.
The authors conclusions are supported by the evidence presented.