Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.

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The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug “load” between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates.MethodsAn observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patient- months data were tabulated. A monthly repeated- measures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations.ResultsThe rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation.ConclusionPreliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total “load” of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.

Potentially traumatic events (PTE) can occur in the life of an individual and can cause long-term psychological harm, including symptoms or diagnosis of posttraumatic stress disorder (PTSD). A large number of youth currently receiving mental and behavioral health services have been exposed to PTE, and a subset of those struggle with distressing and impairing symptoms of PTSD. Often, these youth have not and will not receive appropriate care, which can include Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and trauma-informed care (e.g., Sanctuary). We sought to identify rates of exposure to PTE and expression of PTSD symptoms in youth receiving services in a system of care and found that 95% of the sample reported exposure to at least one PTE (mean = 5). One third of the sample reported a significant burden of PTSD symptoms (5 or more rated highly in the past month). These findings support the trauma-informed care principle of universal precautions in environments that provide mental and behavioral health services to youth. Case vignettes are presented and implications for practice are discussed.