Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

Carlos Rojas-Fernandez,Susan G Brown,Farzan Dadfar,Andrea Wong

doi:10.1186/s13104-015-1557-2

Carlos Rojas-Fernandez, Susan G Brown + Show 2 more

Open Access

https://doi.org/10.1186/s13104-015-1557-2

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Abstract

BackgroundFalls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk.MethodsRetrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings.Results105 residents who fell one or more times during 2009–2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83 % were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42 % of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34 %). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period.ConclusionsThe present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

Highlights

Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) set‐ tings and are associated with significant morbidity and health care use
The objectives of this study were to (1) describe current patterns of Fall-risk increasing drugs (FRIDs) use in LTC and RH residents who sustained one or more falls during a 1-year time period (2009–2010) and (2) to explore current post-fall practices as they relate to the on-going use of FRIDs
Compared to retirement home dwelling residents, those living in long term care had a higher proportion of: residents with a history of one or more prior falls (61 vs %), more than one fall during study period (60 vs %), multiple comorbidities (8 vs 5), conditions associated with increased fall risk such as dementia (63 vs 34 %), osteoarthritis (44 vs 23 %), depression (42 vs 19 %), and visual impairment (63 vs 6 %)

Summary

Introduction

Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) set‐ tings and are associated with significant morbidity and health care use. There are limited data regarding the use of FRIDs in contempo‐ rary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Modifying high risk medications can lower fall risk and fall rates in older people. Van der Velde et al [17] observed a hazard ratio of 0.48 (95 % CI 0.23, 0.99) in a group of geriatric outpatients who had fall risk increasing drugs (FRIDs) withdrawn versus those whose medication regimens remained unchanged. There is support to the notion that modifying high-risk medication regimens can decrease fall risk and fall rates in older people [18]. Failure to consider medications as possible causes/contributors to falls and failure to translate research evidence into practice can hamper any proposed comprehensive fall reduction strategies [9, 15]

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