Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents

Abstract

Objective: To determine if there were any differences in fall risk and actual falls between those who were prescribed and those who were not prescribed psychotropic and psychoactive medications in a skilled nursing facility.

Design: An observational, retrospective cohort study of prospective patient data in a skilled nursing facility.

Setting: A public skilled nursing facility of more than 100 beds.

Patients: Patient charts and consultant pharmacists' drug regimen review monthly report records for 177 patients who were residents for 30 or more days over a 19-month period during 1996-1997 were tabulated.

Interventions: A fall risk using an assessment method that incorporated patient fall history, conditions, diseases, and medications associated with falls was performed on each resident.

Main outcome measures: Patient demographics, medication usage, fall risk, and fall occurrences.

Results: Falls occurred in 107 of 177 (60.5%) residents over the study period. There were 428 documented falls. Fall rates appeared to be directly related to the number of psychotropic drugs, but not other psychoactive medications, until two or more were used concurrently.

Conclusions: Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.