Relationship between the Risk of Falling and Drugs in an Academic Hospital

Abstract

The purpose of this study was to investigate the frequency of inpatient falls and to evaluate the risk factors of drugs in an academic hospital. The study population consisted of inpatients at Ehime University Hospital in Japan and the study was conducted from April 1st to October 31st, 2006. Children and teenagers (＜18 years old) were excluded. Inpatient falls were registered regularly with incident reports submitted by nurses and other hospital employees discovering the fall. Logistic regression techniques were used to estimate the odds ratios (OR) of the association of falls and drug use. Of the 4084 adult patients, 65 (1.6％) fell. An OR (unadjusted) for risk of falling were observed for various drug classes; hypnotics (OR 2.12; 95％ CI, 1.25 to 3.52), anxiolytic (OR 3.35; 95％ CI, 1.83 to 5.82), anti-Parkinson's (OR 5.79; 95％ CI, 1.71 to 14.80), narcotics (OR 3.08; 95％ CI, 1.06 to 7.11), hypotensives, diuretics (OR 2.39; 95％ CI, 1.42 to 3.95). A multivariate logistic regression analysis showed that inpatient falls were signiˆcantly associated with patients older than 70 years (OR, 2.25; 95％ CI, 1.35 to 3.77), with patients taking anxiolytic drugs (OR 2.36; 95％ CI, 1.24 to 4.25), and with patients taking anti-Parkinson's medication (OR 5.04; 95％ CI, 1.44 to 13.43). In conclusion, this study provides information regarding the relationship between fall-related accidents and drugs. Therefore, pharmacists should provide appropriate drug information related to the risk of falling to both patients and medical staŠ members.

Risk factors for falls and their impact on the severity of fall-related injuries

“…We might have missed the association since these neurological conditions were underrepresented in our cohort of internal medicine inpatients. Chronic heart failure and the use of diuretics have been previously described as major fall risk factors in elderly patients [18][19][20][21][22], and were confirmed in our study cohort. Whether the causative mechanism for the association of heart insufficiency and the risk of falling is related to a malsupply of the brain, an impaired stability due to edema, or other consequences, is yet unclear.…”

Medication-related inpatient falls: a critical review

“…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).…”

“…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, …”

“…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).…”

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

“…Results of that case-control study showed strong positive associations at 0 days for all classes of medication (β-blockers, angiotensin-converting enzyme inhibitors, calcium antagonists, thiazides). Surprisingly, only thiazides showed significant ORs of falling during elapsed times of [1][2][3][4][5][6][7][8][9][10][11][12][13][14] 16 A study showed that the current prescribing of angiotensin system-blocking medications, including angiotensin-converting enzyme inhibitors and angiotensinreceptor blockers, had a protective effect against fall risk in older people. 29 This prospective cohort study in 520 community-dwelling older people indicated that people taking angiotensin system-blocking medications were less likely to fall (OR 0.68, 95% CI 0.48-0.97; P,0.05) after adjusting for potential confounders.…”