Influence of medications and psychotic symptoms on fall risk in acute psychiatric inpatients

Lu, Shen-Hua; Chen, Kuang-Huei; Pan, Ying-Chieh; Yang, Szu‐Nian; Chan, Yao-Chia

doi:10.4103/jmedsci.jmedsci_132_17

Cited by 6 publications

(14 citation statements)

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“…Six studies were excluded for the reasons listed in Figure 1. Another four studies were identified from the reference list, and nine studies were included in this review (Aso & Okamura, 2019; Chang & Jen, 2021; Lu et al, 2018; Seeherunwong et al, 2022). The search strategy is presented in the PRISMA framework, shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies were conducted in the United States (Estrin et al, 2009; Lavsa et al, 2010; Tsai et al, 1998) and Taiwan (Chan et al, 2013; Chang & Jen, 2021; Lu et al, 2018), one study in China (An et al, 2009), Japan (Aso & Okamura, 2019) and Thailand (Seeherunwong et al, 2022). The duration of study timeframe ranges from 3 months (Aso & Okamura, 2019) to 5 years (Chang & Jen, 2021; Estrin et al, 2009; Lavsa et al, 2010; Seeherunwong et al, 2022).…”

Section: Resultsmentioning

confidence: 99%

“…Blood , 1998), and four studies did not control for confounders in the analysis (Aso & Okamura, 2019;Lu et al, 2018;Tsai et al, 1998).…”

Section: Dizzinessmentioning

confidence: 99%

“…The location of fall and activity being undertaken by the patient at the time of the fall vary across the studies. Most studies reported patients falling at night (An et al, 2009;Lu et al, 2018;Seeherunwong et al, 2022), but they did not sustain any injury from the fall (An et al, 2009;Chan et al, 2013). adults aged above 65 (Carpels et al, 2022).…”

Section: Circumstances Of Fallmentioning

confidence: 99%

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Factors associated with risk of falling among younger inpatients in a mental health setting—A systematic review

Ngune,

Ang,

Nadew

et al. 2023

Journal of Clinical Nursing

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AimTo synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤65 years old.BackgroundHospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood.DesignSystematic review.MethodsMedline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted.ResultsNine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio‐demographic, fall‐related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies.ConclusionFactors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta‐analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used.Relevance to clinical practiceFall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting.Patient and public contributionPatient or public contribution was not possible because of the study design.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Blood , 1998), and four studies did not control for confounders in the analysis (Aso & Okamura, 2019;Lu et al, 2018;Tsai et al, 1998).…”

Section: Dizzinessmentioning

confidence: 99%

Section: Circumstances Of Fallmentioning

confidence: 99%

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Factors associated with risk of falling among younger inpatients in a mental health setting—A systematic review

Ngune,

Ang,

Nadew

et al. 2023

Journal of Clinical Nursing

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“…For psychiatric patients, the issue of falling is even more complex. Due to their disease(s) or medications, psychiatric patients are more likely to be prone to inattention, sensory perception disorders, too little or increased activity, disorientation, or lack of judgment, all of which increase the risk of falling (Allen et al, 2012; Lu et al, 2018; van Dyke et al, 2014). However, few studies have conducted a comprehensive investigation on the specifics of falling among psychiatric patients or compared the risk factors for falling between psychiatric patients and general ward inpatients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Risk Factors of Falling for Psychiatric Inpatients and General Ward Inpatients Who Had Fallen

Chang

Jen

2021

J Am Psychiatr Nurses Assoc

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BACKGROUND: For psychiatric patients, the issue of falling is complex. OBJECTIVE: The objective of this study was to compare the risk factors for falling in psychiatric inpatients and general ward inpatients who had fallen. METHODS: The researchers first derived official fall records for 122 psychiatric inpatients and then selected 122 psychiatric inpatients who had not fallen as well as 122 general ward patients who had fallen, matched for gender, age, and length of hospital stay at the time of the fall incident. RESULTS: After controlling other variables, multinomial logistic regression analysis revealed that psychiatric inpatients who had fallen and had dizziness (odds ratio [OR] = 7.11, p < .001), had an unsteady gait (OR = 1.97, p = .030), or were not using aids (OR = 0.42, p = .042) were at greater risk of falling than those who had not fallen. The researchers also found that general ward inpatients who had fallen and had higher Charlson Comorbidity Index scores (OR = 1.77, p < .001), were clear-headed (OR = 27.15, p = .001), had dizziness (OR = 11.55, p < .001), were unable to walk (OR = 64.28, p < .001), or were using aids (OR = 3.86, p = .001) were at greater risk of falling than those who had not fallen before. CONCLUSIONS: The causes of falling among psychiatric inpatients and general ward inpatients are different. Medical personnel should understand the medications and attributes of patients for an accurate assessment of their risk factors for falling and thus implement fall prevention measures and health education to reduce falls.

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Staffing and patient-related factors affecting inpatient falls in a psychiatric hospital: a 5-year retrospective matched case–control study

Seeherunwong

Thunyadee

Vanishakije

et al. 2022

Int J Ment Health Syst

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Background The frequency and severity of falls of psychiatric inpatients in Thailand have not been previously reported. Also, the risk factors of falls have been numerous and complicated. This study aimed to investigate the staffing factors and patient-related factors that increase the likelihood of falls among psychiatric inpatients. Methods A five-year retrospective matched case–control study was conducted that selected cases of inpatients who fell and which were reported to the hospital risk management system. Subjects were compared to two control patients from the same hospital (1:2) by age (± 5 years), sex, and admission the same year. The total sample consisted of 240 patients. Univariate and multivariate conditional logistic regression was used to analyze the data. Results Of the eighty falls, 86.3% resulted in temporary harm and required intervention. The multivariate model showed that three patient-related factors were associated with increased inpatient falls: (1) having an acute psychotic condition (adjusted odds ratio (AOR) = 4.34; 95% CI 1.45, 13.05; p < 0.05), (2) polypharmacy with more than four types of medicines (AOR = 3.06; 95% CI 1.59, 5.88; p < 0.05), and (3) taking atypical psychiatric drugs (AOR = 2.74; 95% CI 1.35, 5.58; p < 0.05). Staffing for 26–50 patients in the wards was more protective for falls than with 25 or fewer patients (AOR = .17; 95% CI 0.04, 0.72; p < 0.05). Conclusions The risk factors found may help assess fall risk and manage the number of patients in psychiatric units. Drug dosage and drug interaction of antipsychotic drugs and cardiovascular agents with other medications and drug administration timing before falls are recommended for further investigation. Also, staff ratio per patient and the proportion of staff mix in psychiatric units need further study to establish adequate levels of surveillance to prevent inpatient falls.

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Influence of medications and psychotic symptoms on fall risk in acute psychiatric inpatients

Cited by 6 publications

References 0 publications

Factors associated with risk of falling among younger inpatients in a mental health setting—A systematic review

Factors associated with risk of falling among younger inpatients in a mental health setting—A systematic review

Comparison of Risk Factors of Falling for Psychiatric Inpatients and General Ward Inpatients Who Had Fallen

Staffing and patient-related factors affecting inpatient falls in a psychiatric hospital: a 5-year retrospective matched case–control study

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