藥物與老人跌倒

Medication and Fall in Elderly

老人是跌倒事件的高危險群，為瞭解老人跌倒與多重用藥之相關性，本文針對各種致跌藥物之作用機轉及風險進行文獻探討。藥物導致跌倒係因神經方面副作用，如混亂、憂鬱、鎮靜、心律不整等，或因藥物引起姿勢性低血壓所致。文獻已證實使用鎮靜安眠劑、抗精神病用藥及抗憂鬱劑，與跌倒有顯著相關。BZD類鎮靜安眠藥，無論長短效皆會增加跌倒風險，且其風險與劑量高低有關：典型或非典型抗精神病藥物、三環類抗憂鬱劑、選擇性血清抑制劑、心臟血管用藥及止痛劑等，皆會增加跌倒風險。而預防之道在於精簡用藥品項，選用低風險藥物，若需用致跌高風險藥物，應由低劑量開始，再逐漸調整，並加強病人衛教，以有效預防因藥物導致跌倒之不幸事件。

Elderly patients are at high risk of falls. The aim of this study was to identify the relationship of polypharmacy and falls. Many of the medications that increase the risk of falling have neurological side effects, including confusion, depression, sedation, and arrhythmia as well as drug-induced orthostatic hypotension. The literature has found a significant association between the use of sedatives and hypnotics, antipsychotics, and the event of falls. We found that short- and long-acting benzodiazepines, typical and atypical antipsychotics, tricyclic antidepressants, selecive serotonin reuptake inhibitors, cardiovascular drugs, and analgesics to be associated with increased risk of falls. Prevention strategies of drug-related falling include reduction in the number of medications taken, avoiding high -risk-increasing drugs or using the lowest dose possible, and reinforcing patient education.