Fall risk associated with inpatient medications

Lamis, Rebecca L.; Kramer, Joan; Hale, LaDonna S.; Zackula, Rosey; Berg, Gina M.

doi:10.2146/ajhp110723

Cited by 20 publications

(22 citation statements)

References 27 publications

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“…Fifty seven percent of the studies did not specify the medication, class or substances included in the group (only mentioned, for instance, sedative hypnotics, without indicating any specific drug) (Costa-Dias et al, 2014;Pierce Jr. et al, 2013;Obayashi et al, 2013;Lamis et al, 2012;Chang et al, 2011;Bun, Serby, Friedmann, 2011;Mamun, Lim, 2009;Tanaka et al, 2008;Angalakuditi, Gomes, Coley, 2007;Vassalo et al, 2006;Krauss et al, 2005;Vassalo et al, 2004;Aisen, Deluca, Lawlor, 1992). Some articles focused their studies on all central nervous system medications (Lamis et al, 2012) (without establishing any distinction between the pharmacological groups).…”

Section: Resultsmentioning

confidence: 99%

“…Some articles focused their studies on all central nervous system medications (Lamis et al, 2012) (without establishing any distinction between the pharmacological groups). Some studies grouped more than one pharmacological group (Costa-Dias et al, 2014;Vassalo et al, 2006).…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies attributed inpatient falls to anxiolytics use (Tapper, Risech-Neyman, Segupta, 2015;O'Neil et al, 2015;Mamun, Lim, 2009;Lamis et al, 2012;Frels, 2002;Dauphinot et al, 2014;Costa-Dias et al, 2014;Tanaka et al, 2008;Chang et al, 2011;Angalakuditi, Gomes, Coley, 2007;Shuto et al, 2010;Cashin, Yang, 2011;Vassalo et al, 2004;Mendelson, …”

Section: Anxiolyticsmentioning

confidence: 99%

“…Most of the studies were devoted to special populations (Tapper et al, 2015;Costa-Dias et al, 2014;Vassalo et al, 2006;Aisen, Deluca, Lawlor, 1992;Bun, Serby, Friedmann, 2011) and only three placed no restrictions on the study population (Lamis et al, 2012;Dauphinot et al, 2014;Mendelson, 1996). The chemical substances included: olanzapine, risperidone, amisulpride, tiaprida, ciamemazine, quetiapine and haloperidol.…”

Section: Antipsychoticsmentioning

confidence: 99%

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Medication-related inpatient falls: a critical review

Ribeiro

Melo

Maia

et al. 2018

Braz. J. Pharm. Sci.

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Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Anxiolyticsmentioning

confidence: 99%

Section: Antipsychoticsmentioning

confidence: 99%

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Medication-related inpatient falls: a critical review

Ribeiro

Melo

Maia

et al. 2018

Braz. J. Pharm. Sci.

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“…Results of that case-control study showed strong positive associations at 0 days for all classes of medication (β-blockers, angiotensin-converting enzyme inhibitors, calcium antagonists, thiazides). Surprisingly, only thiazides showed significant ORs of falling during elapsed times of [1][2][3][4][5][6][7][8][9][10][11][12][13][14] 16 A study showed that the current prescribing of angiotensin system-blocking medications, including angiotensin-converting enzyme inhibitors and angiotensinreceptor blockers, had a protective effect against fall risk in older people. 29 This prospective cohort study in 520 community-dwelling older people indicated that people taking angiotensin system-blocking medications were less likely to fall (OR 0.68, 95% CI 0.48-0.97; P,0.05) after adjusting for potential confounders.…”

mentioning

confidence: 99%

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

Zhou¹,

Chen²,

Zhu³

2014

OTT

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Background: Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Falls prevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an upto-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods: Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results: Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer's agents, antiplatelet agents, calcium antagonists, diuretics, α-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug-drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion: Based on the literature review, clear practical recommendations for clinicians to prevent falls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient's medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could ...

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