We thank Wilson and colleagues for sharing their finding that baseline use of PPIs was not associated with 12-month mortality among 602 participants in a falls prevention study. As highlighted by Wilson and colleagues, prescribing practices and organization of care for older people often differ within and between countries. We agree that the specialized nature of our study cohorts limits extrapolation to other populations.
Twelve-month mortality among the residents of intermediate-level aged care facilities studied by Wilson and colleagues was 10.3% compared with 28.2% and 24.9% in our 2 cohorts.1 In addition to possible differences in organization of care, the lower mortality may attributed to the fact that residents were only eligible for inclusion in their falls prevention study if facility staff judged that they were likely to survive for 12 months.2 It is possible, therefore, that frail residents most susceptible to adverse drug events associated with PPIs were not included in the study.
Bell JS, Strandberg TE, Pitkälä KH. Use of PPIs Are Not Associated With Mortality in Institutionalized Older People—Reply. Arch Intern Med. 2011;171(9):866-867. doi:10.1001/archinternmed.2011.165