Over Half of Falls Were Associated with Psychotropic Medication Use in Four Nursing Homes in Japan: A Retrospective Cohort Study

Nozomu Oya, Nobutaka Ayani, Akiko Kuwahara, Riki Kitaoka, Chie Omichi, Mio Sakuma, Takeshi Morimoto and Jin Narumoto
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Nozomu Oya: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Nobutaka Ayani: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Akiko Kuwahara: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Riki Kitaoka: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Chie Omichi: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Mio Sakuma: Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
Takeshi Morimoto: Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
Jin Narumoto: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan

IJERPH, 2022, vol. 19, issue 5, 1-11

Abstract: Medication use can increase the risk of falls and injuries in nursing homes, creating a significant risk for residents. We performed a retrospective cohort study over one year to identify the incidence of drug-related falls with and without injury among four Japanese nursing homes with 280 beds. We evaluated the relationship between potential risk factors for falls and fall-related injuries while considering well-known risks such as ADLs and chronic comorbidities. By collaboratively reviewing care records, we enrolled 459 residents (mean age, 87) and identified 645 falls, including 146 injurious falls and 16 severe injurious falls requiring inpatient care, incidence: 19.5, 4.4, 0.5 per 100 resident-months, respectively. Medication influenced around three-quarters of all falls, >80% of which were psychotropic drugs. Regularly taking ≥5 medications was a risk factor for the initial falls (HR 1.33: CI 1.00–1.77, p = 0.0048) and injuries after falls (OR 2.41: CI 1.30–4.50, p = 0.006). Our findings on the incidence of falls with and without injury were similar to those in Western countries, where the use of psychotropic medication influenced >50% of falls. Discontinuing unnecessary medication use while simultaneously assessing patient ADLs and comorbidities with physicians and pharmacists may help to avoid falls in nursing homes.

Keywords: fall; adverse drug event; nursing home; psychotropic drugs; polypharmacy; dementia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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