Medication use as a risk factor for inpatient falls in an acute care hospital: a case‐crossover study

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Benzodiazepines, antidepressants, antipsychotic agents, anti-arrhythmic agents, opioid analgesics and antihypertensive agents including a-receptor antagonists and b-receptor antagonists, but not angiotensin II receptor antagonists, have been implicated as risk factors for falls among community dwelling elderly people, and those in aged care hospitals and nursing homes. WHAT THIS STUDY ADDS• Using a case-crossover design, the study's findings provide the first evidence suggesting that newly initiating treatment using an angiotensin II receptor antagonist, candesartan, or etizolam, biperiden and zopiclone may be potential risk factors for falls in acute hospitals. AIMSThe present study aimed to evaluate the associations between medication use and falls and to identify high risk medications that acted as a trigger for the onset of falls in an acute care hospital setting. METHODSWe applied a case-crossover design wherein cases served as their own controls and comparisons were made within each participant. The 3-day period (days 0 to -2) and the 3-day periods (days -6 to -8, days -9 to -11 and days -12 to -14) before the fall event were defined as the case period and the control periods, respectively. Exposures to medications were compared between the case and control periods. Odds ratios (OR) and 95% confidence intervals (CI) for the onset of falls with respect to medication use were computed using conditional logistic regression analyses.

Caracterização das quedas de pacientes em hospital especializado em cardiologia

“…[19][20] Neste contexto, os medicamentos com repercussões fisiológicas merecem atenção da equipe de enfermagem no sentido de prevenir a ocorrência de quedas. Para que o profissional consiga ter esse olhar deve possuir conhecimentos e aplicar a sistematização de enfermagem, ferramenta indispensável para implementação de assistência individualizada e pautada nas demandas de cuidado.…”

Inpatient Falls

“…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 …”

The incidence of falls among geriatric outpatients in relation to the number and types of drugs taken

“…The findings of Huang et al [19] confirm that ingestion of four or more drugs, irrespective of their pharmacological group, raises a risk of falls. according to Shuto et al [20] exposure to falls is greater among patients taking hypotensive and psychotropic drugs. The research conducted by gales and Menard [21] shows that the incidence of falls among patients with cardiac insufficiency is related to digoxin therapy, benzodiazepine treatment, or taking at least three psychoactive drugs.…”