The Association between Psychotropic Medication Use and Gait and Mobility Impairment in Community-Dwelling Older People. Data from The Irish Longitudinal Study on Ageing (TILDA)

Background: Little work to date has quantified the effect of psychotropic medications (antidepressants, benzodiazepines, 'Z' drugs, antipsychotics, anticholinergics) on mobility and gait in later life. The aim of this study is to examine the relationship between these medications and mobility/gait parameters in a large cohort of community-dwelling older people.

Methods: Participants were included if they were ≥60 years at TILDA Wave 1 and underwent gait and mobility assessment (Gaitrite system), with follow-up at Wave 3 (4 years). Medication lists were examined for psychotropic medications. Regression models assessed the relationship between psychotropic medications and mobility, using the following parameters: Timed Up and Go (TUG), gait speed, step length / width, double support phase. Multilevel modelling assessed trajectories of mobility/gait variables over time by psychotropic use.

Results: Of 2620 patients, 12% were prescribed ≥1 psychotropic medication, 3% prescribed ≥2 psychotropics. Cross-sectionally, psychotropic medication was independently associated with prolonged TUG (β=0.50 (95% CI 0.27-0.73); p<0.001), slower gait speed (β=-5.65 (95% CI -7.92 - -3.38); p<0.001), shorter step length (β=-2.03 (95% CI -2.93 - -1.42); p<0.001) and increased double support phase (β=0.47 (95% CI 0.19-0.75); p=0.001).Longitudinally, psychotropic use was independently associated with transition to abnormal TUG (OR 2.68 (95% CI 1.55-4.64), p<0.001), while using ≥2 psychotropics was associated with transition to slower gait speed (OR 2.59 (95% CI 1.01-6.68); p=0.048).

Conclusions: Psychotropic use was associated with significantly poorer mobility and gait performance, both cross-sectionally and longitudinally. It is imperative that psychotropic medication use is reviewed as part of comprehensive geriatric assessment.