Medication-related inpatient falls: a critical review

Abstract

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.

The relation between falls and medication use among elderly in assisted living facilities

“…Although diuretics and its recent dose change were more in fallers, they were not significant predictors of falls. Previous data had some controversies, even though diuretic use might be related to the urgency to get up and move quickly, which could expose them to risky behavior . These factors could be masked by adjustment for environomental hazzards, which depends not only on physical factors but also on human actions .…”

“…Some controversies exist between recent systematic reviews, regarding impact of antihypertensives on falls in older adults …”

Pharmacotherapy as major risk factor of falls - analysis of 12 months experience in hospitals in South Bohemia

“…Underestimating the drug-related cause of falls is not appropriate (Ribeiro et al, 2018). On the other hand, it is necessary to recall the multifactorial nature of falls, which makes the assessment difficult.…”

Efetividade de tecnologia educacional para prevenção de quedas em ambiente hospitalar

“…(29) Revisão de literatura infere que a ocorrência de quedas em pacientes hospitalizados foi atribuída a ansiolíticos, hipnóticos e sedativos (48%), antipsicóticos (35%), opioides e antiepiléticos (30%) e antidepressivos (22%). (30) Ao reconhecer os riscos de quedas relacionados a determinados grupos de fármacos os pacientes se tornam ativos no processo de cuidado e parceiros nas intervenções propostas pelos profissionais de saúde.…”