Abstract
Medication use can increase the risk of falls and injuries in nursing homes, creating a significant risk for residents. We performed a retrospective cohort study over one year to identify the incidence of drug-related falls with and without injury among four Japanese nursing homes with 280 beds. We evaluated the relationship between potential risk factors for falls and fall-related injuries while considering well-known risks such as ADLs and chronic comorbidities. By collaboratively reviewing care records, we enrolled 459 residents (mean age, 87) and identified 645 falls, including 146 injurious falls and 16 severe injurious falls requiring inpatient care, incidence: 19.5, 4.4, 0.5 per 100 resident-months, respectively. Medication influenced around three-quarters of all falls, >80% of which were psychotropic drugs. Regularly taking ≥5 medications was a risk factor for the initial falls (HR 1.33: CI 1.00–1.77, p = 0.0048) and injuries after falls (OR 2.41: CI 1.30–4.50, p = 0.006). Our findings on the incidence of falls with and without injury were similar to those in Western countries, where the use of psychotropic medication influenced >50% of falls. Discontinuing unnecessary medication use while simultaneously assessing patient ADLs and comorbidities with physicians and pharmacists may help to avoid falls in nursing homes.
Highlights
Aging is a global trend, especially in developed countries, and the number of older adults receiving care services is growing
We identified potential triggers of falls (Table 2), and as a result, approximately three-quarters of falls (74.4%, 480/645) were influenced by medication immediately before the fall (i.e., adverse drug event (ADE)), with psychotropic drugs accounting for 86.8% of all medications
The high number of falls caused by antiepileptics may be a result of commissioned physicians’ attempt to avoid the use of benzodiazepine receptor agonists (BZDRAs) and antipsychotics, which have been shown to be harmful to older adults with dementia
Summary
Aging is a global trend, especially in developed countries, and the number of older adults receiving care services is growing. The number of older adults who require care services in Japan has increased from 1.8 million in 2000 to 5.5 million in 2018 [2]. States where 1.9 million adults of 65 years and over have received some care services in elderly care facilities [4], accounting for 12% of the older adults and 33% of all recipients of elderly care services in the United States. This suggests that many developed countries will face an increase in the number of elderly residents in the future
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