Psychotropic Drugs Associated With Increased Risk for Falls

Abstract

Results from a retrospective observational study conducted in the Netherlands show that patients who are prescribed psychotropic drugs are at a significantly increased risk for falls. Taking psychotropic drugs on a scheduled basis was associated with an almost threefold increase in the incidence of falls. Researchers found that the risk was increased for both antipsychotics and antidepressants (J Am Med Dir Assoc 2016;17:1089–93). Psychotropic drugs (taken only on an as-needed basis) and benzodiazepines were associated with an increased risk of falls as well, although these associations did not reach statistical significance. Researchers also found that a combination of two or three of these drug classes was associated with increased risk. Researchers evaluated 2,368 nursing home residents at nine locations in Eindhoven, the Netherlands, for a total of 538,575 person-days. The mean age of the study participants was 83.9 years, and the mean follow-up period was 506 days. All residents who stayed at one of the locations for at least 1 day from May 2012 through April 2014 were included, but residents in palliative units were excluded. The mean number of psychotropic drug prescriptions per person-day was 1.2. A total of 1,629 patients (68.8%) were prescribed at least one psychotropic drug per day during a total of 318,128 person-days (59.1%). Scheduled prescriptions with or without an as-needed prescription were assigned on a total of 270,781 person-days (50.3%). Only prescriptions on an as-needed basis were assigned on 47,347 person-days (8.8%). Benzodiazepines were the most commonly prescribed class of drug. A total of 794 residents (33.5%) experienced at least one fall on 2,453 person-days (0.5%), for a fall incidence of 1.7 falls per person-year. Most falls occurred on days when a psychotropic drug was prescribed on a scheduled basis, with or without an as-needed prescription (1,652 person-days, 0.6%). At least one fall per person-day occurred on 175 person-days (0.4%) when a drug was prescribed on an as-needed basis only. At least one fall per person-day occurred on 618 person-days (0.3%) on days when no psychotropic drugs were prescribed. By percentage of person-days, falls were most likely to occur in patients taking antipsychotics (Table 1). Source: J Am Med Dir Assoc 2016;17:1089–93. “In subgroup analysis, only the prescription of benzodiazepines on a scheduled basis showed no statistical significant association,” the researchers wrote. “A hypothesis for this finding could be the fact that prolonged use of benzodiazepines results in adaptation of benzodiazepine receptors and could lead to habituation. For that reason, fall incidence could be lower while using a benzodiazepine on a scheduled basis as compared to incidental use.” The researchers also noted that fall risk was much higher for men. “Our finding that males were 87% more at risk of falling could possibly be explained by the higher prevalence of antipsychotic and antidepressant prescriptions among the male residents of our study population. However, it is also possible that our male residents had a diversity of comorbidities that influenced fall risk.” Jason Harris is a freelance writer based in Philadelphia.