Psychotropic Drug Prescription and the Risk of Falls in Nursing Home Residents

Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study

“…The work replicates the findings of research undertaken in care home populations internationally that found an association between risk of falling and the number of drugs used [15,16]. Our findings show that the association between falls and psychotropic prescriptions is as strong in the UK care home population as it is in nursing homes internationally and non-care home settings [3,8,17,18]. In our study, falls were associated with antidepressants and benzodiazepines, but not with antipsychotics.…”

“…Medication inclusion or exclusion decisions were considered independently by two researchers to minimise error. The Anatomical Therapeutic Chemical (ATC) classification system was used to classify psychotropic drugs and create an adapted version of the classification used by Cox et al [8]. This classification and the psychotropic drugs prescribed are shown in "Appendix B".…”

“…Doctors may be tempted to prescribe psychotropic medications to reduce behaviours such as wandering, which are felt to be risk factors for falls, or they may be unsure about the size of risk of falls associated with them. Psychotropic drug prescriptions in Dutch Nursing Home residents are associated with a threefold increase in falls risk [8]. Dutch Nursing Homes are, though, organised differently from UK care homes and, importantly, have differing practises regarding physical restraint-so associations seen in one country may not be replicated elsewhere [9].…”

Geriatric Aspects of Frail Nursing Home Residents : A Swedish cohort study

“…Despite the fact that the nursing home population has a high fall risk, few recent studies focus on associations between drug use and fall risk in nursing homes. However, the use of psychotropic drug classes such as antipsychotics [85][86][87], antidepressants [85] and benzodiazepines [86,87] is associated with fall risk in nursing homes. Non-benzodiazepine hypnotics, considered to be well tolerated in older people [88], usually recommended for insomnia in older people [73,89,90], and more often used in nursing homes than in home environments [91], are reported to be associated with an elevated risk of hip fractures in one nursing home study [92].…”

PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

“…Decision-making is a key skill for many healthcare professionals and is important to ensure patient safety [13].PRN prescription and administration is commonly used for psychotropic and psycholeptics medications, including antipsychotics, neuroleptics, anxiolytics, sedatives, and hypnotics [6,8,9,[14][15][16][17][18], analgesics [6,12,14,[19][20][21], gastro-intestinal preparations [12,14], and other physical and psychological symptoms [2]. Benefits of PRN administration to patients are noted [2,9], but the use of PRN psychotropic medications has been linked to an increased risk of falls [22][23][24], infection, or dehydration [24]. PRN medication is associated with dementia diagnosis, older age, polypharmacy, and a longer length of stay in nursing homes [8,25].…”