Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study

Chang, Chia‐Ming; Chen, Ming‐Jen; Tsai, Chi-Ying; Ho, Lun‐Hui; Hsieh, Hsing-Ling; Chau, Yeuk-Lun; Liu, Chia-Yih

doi:10.1002/gps.2569

Cited by 80 publications

(75 citation statements)

References 33 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%

“…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%

“…Among these studies, two study populations were, however, restricted to elderly patients. Most of the studies did not specify the medication employed in their investigation (Hayakawa et al, 2014;Kolla et al, 2013;Costa-Dias et al, 2014;Tanaka et al, 2008;Chang et al, 2011;Krauss et al, 2005) while four others mentioned the following medications: zolpidem, zopiclone (Kolla et al, 2013;Dauphinot et al, 2014;Chang et al, 2011), brotizolam, flunitrazepam, lormetazepam, midazolam, nitrazepam, quazepam, rilmazafone, triazolam (Shuto et al, 2010Obayashi et al, 2013;Mendelson, 1996).…”

Section: Hypnotics and Sedativesmentioning

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: Anxiolyticsmentioning

confidence: 99%

Section: Hypnotics and Sedativesmentioning

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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“…8,16,17,[27][28][29][30][42][43][44][45][46][47][48] Medications including benzodiazepines, anticonvulsants, antihypertensives, antidepressants, and sleep aids have also been targeted as high-risk medications. 8,[26][27][28][31][32][33][34][35]42,[49][50][51][52][53][54][55][56] Two additional risk factors that are often mentioned are male sex and poor functioning or inability to independently perform activities of daily living. 13,15,19,24,27,35,56,57 …”

Section: Risk Stratificationmentioning

confidence: 99%

Inpatient Falls

Cumbler

Simpson

Rosenthal

et al. 2013

The Neurohospitalist

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In this 2 part series, analysis of the risk stratification tools that are available, definition for the scope of the problem, and potential solutions through a review of the literature are presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, Morse Fall Scale, and the Hendrich Fall Risk Model. Of these scoring systems, the Hendrich Fall Risk Model is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement is discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach which is broadly applicable to other areas requiring quality improvement.

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“…Many descriptive, retrospective, and prospective studies report activities related to elimination as a common contributing factor to inpatient fall events [5][6][7] . Further, the role of medication use/polypharmacy is also well documented as being an independent risk factor for fall events; especially in the geriatric population in both the inpatient and outpatient arenas [8][9][10][11] . Additionally, studies have described the relationship between altered cognition and patient falls in a variety of settings [12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Decreasing Inpatient Falls: A Retrospective Analysis with CNS-Led Interventions

Cioffi

Plumadore

Clark

2012

JHA

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Objective: To identify and analyze associations between characteristics and factors collected on the 'Post Fall Huddle/Event Report' form used by Nursing and Risk Management for all inpatient falls. Inpatient falls were defined as any hospitalized patient that had a fall event during their stay. Methods and materials:All inpatient falls, 17 years and older, were included within a six month period for a sample size of 182. SPSS was used for analyses to identify associative predictors.Results: When examining the number of inpatient falls post implementation of the form, the average annual number of inpatient falls decreased by 50%. Several strategies implemented by Clinical Nurse Specialists to be continued include in-depth review of circumstances surrounding the fall; education of staff for consistency in the fall protocol; and reinforcement of purposeful hourly rounding.Conclusions: Suggested associations with injury or increased length of stay included patients with elimination problems, on antihypertensive medications, a higher patient census at the time of the fall on the unit, and any other medication changes. Further revisions continue to increase the objectivity on the' Post Fall Huddle/Event Report' form.

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Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study

Abstract: Strategies to prevent falls in older people in hospital should include minimizing the use of zolpidem, benzodiazepine, narcotics, and antihistamines, especially in cancer patients.

Cited by 80 publications

References 33 publications

Medication-related inpatient falls: a critical review

Medication-related inpatient falls: a critical review

Inpatient Falls

Decreasing Inpatient Falls: A Retrospective Analysis with CNS-Led Interventions

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