Effects of Age, Helicobacter Pylori , and Nsaid Usage on the Upper Gastrointestinal Tract (original) (raw)

Journal of the American Geriatrics Society, 1996

Abstract

To the Editor: Medication use is potentially the most modifiable risk factor for falls in older persons, and it is of particular interest clinically, as stated in the excellent review by Drs. King and Tinetti. 1 Surprisingly, among the eight FICSIT Trialsr' the optimizing of medication use was a component of the interventions in one trial only.:' Critical medication reviews were performed focussing on three important issues, (1) postural hypotension, (2) the use of sedative hypnotics benzodiazepines and sleeping medications, and (3) multimedication (;=:4 medications). Medications of special interest, targeted medications, were diuretics, antihypertensives, nitrates, anti~epressa?ts, H 2 blockers, and NSAIDS, apart from hypnotics/sedatives." A recent report indicated that either the use of ~ntide~ressants, any psychotropic medication, centrally act109 antihypertensives, narcotic analgesics, insulin, or the total number of prescribed medications was associated with falls in persons aged 72 years and older living in the comrnuniry.f Postural blood pressure changes (postural hypotension?) were not associated with falling. The data from the intervention trial showed there were no differences in the prevalence of postural hypotension, and of the use of sedative-hypnotic agents, at the time of reassessment. However, as part of the intervention, 55 of 70 persons with postural hypotension, and 19 of 29 persons who used sedative-hypnotic agents, had received medication adjustments. There was a remarkable difference in the prevalence of using four or more medications.:~ The results of this trial, as well as recent data,S,6 bring us to the following questions. For which types of medications were dosages adapted, and which drugs were most often d!scontinued or substituted? Although it is impossible to disentangle the contributions of single components of that multifactorial intervention, information about the kind of medication adjustments would provide at least some hints for further research. With regard to risk constellations, it may be worthwhile to evaluate whether there are associations between falls and combinations of certain, rather than single targeted medicarions.I-" and whether there is also a possible relationship to postural hypotension/postural blood pressure changes.Y'"

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