Psychotropic Drug Prescription and the Risk of Falls in Nursing Home Residents

Claudia A Cox,Heike J Van Jaarsveld,Saskia Houterman,John C.G.H Van Der Stegen,Arthur T.M Wasylewicz,Rene J.E Grouls,Carolien M.J Van Der Linden

doi:10.1016/j.jamda.2016.07.004

Abstract

BackgroundFalling is a common and serious problem in the elderly. Previous studies suggest that the use of psychotropic drugs increases the risk of falling. However, the contribution of these drugs on fall risk has not been quantified on a daily basis among the general population of nursing homes until now. ObjectiveTo assess the association between fall incidence and the prescription of psychotropic drugs and different categories of psychotropic drugs (antipsychotics, antidepressants, and benzodiazepines) among a general nursing home population. DesignRetrospective observational study, data collection per person-day. Setting9 nursing homes in Eindhoven, the Netherlands. Participants2368 nursing home residents, resulting in 538,575 person-days. Main outcome measureAssociation between the prescription of psychotropic drugs and falls. ResultsA total of 2368 nursing home residents were included, which resulted in a data set of 538,575 person-days. Prescription of at least 1 psychotropic drug per day occurred during a total of 318,128 person-days (59.1%). Scheduled prescriptions with or without an as-needed prescription were involved in a total of 270,781 person-days (50.3%). The prescription of psychotropic drugs on a scheduled basis was found to be associated with almost a 3-fold increase in fall incidence (OR 2.88; 95% CI 1.52–5.44). An increase in fall incidence was found following the prescription of antipsychotics (OR 1.97; 95% CI 1.51–2.59) and antidepressants (OR 2.26; 95% CI 1.73–2.95). This increased fall risk was found for prescriptions on a scheduled basis as well as for prescriptions on an as-needed basis. ConclusionThe prescription of psychotropic drugs is associated with a strongly increased risk of falling among nursing home residents. To our knowledge, this is the first study among the general nursing home population in which the association between daily falls and daily prescriptions of psychotropic drugs and groups of psychotropic drugs was specified.

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