title: Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?
abstract: BACKGROUND
  Polypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls.
  
  
  METHODS
  A retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents.
  
  
  RESULTS
  221 residents (75.4%) were female and 72 (24.6%) male, and 133 (45.4%) were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4%) and major in 46 (32.6%). Only fall dynamics (p = 0.013) and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (> or =7 medications) seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36).
  
  
  CONCLUSIONS
  This work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.
authors.affiliation: Dipartimento di Medicina Clinica, Università degli Studi dell'Insubria, Via O Rossi 9, 21100 Varese, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Baranzini
authors.forename: Marcello
authors.initials: M
authors.lastname: Diurni
authors.forename: Francesca
authors.initials: F
authors.lastname: Ceccon
authors.forename: Nicola
authors.initials: N
authors.lastname: Poloni
authors.forename: Sara
authors.initials: S
authors.lastname: Cazzamalli
authors.forename: Chiara
authors.initials: C
authors.lastname: Costantini
authors.forename: Cristiano
authors.initials: C
authors.lastname: Colli
authors.forename: Laura
authors.initials: L
authors.lastname: Greco
authors.forename: Camilla
authors.initials: C
authors.lastname: Callegari
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D019338:Polypharmacy; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology