title: New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home.
abstract: OBJECTIVE
  Although chronic use of diuretics has been implicated as a risk factor for falls, it is unknown whether changes in diuretic drugs are associated with an acutely elevated risk of falls. We evaluated the relationship between change in a diuretic prescription (new prescription or increased dose) and the occurrence of documented falls among nursing home residents.
  
  
  METHODS
  Participants of the cohort were 1785 long-term care residents of two large nursing homes (2005-2010; Boston, MA). A self-matched, case-crossover analysis was used to examine whether there is an acutely increased risk of falling in the day following a diuretic drug change compared with days without a diuretic drug change. Odds ratios with 95% confidence intervals were calculated using conditional logistic regression models.
  
  
  RESULTS
  During a mean follow-up of 8.4 months, 1181 participants experienced an incident fall. Nine participants experienced a diuretic change on the day before the fall. The odds of falling one day following a change in a diuretic was elevated (OR = 2.08; 95% CI = 0.89, 4.86). The association was stronger and reached nominal statistical significance when loop diuretics were examined separately (OR = 2.46; 95% CI = 1.02, 5.92). We estimated that, for every 271 loop diuretic drug changes, one excess fall occurred.
  
  
  CONCLUSIONS
  Nursing home residents are at an increased risk of falls in the day following a new prescription or increased dose of a loop diuretic drug. Extra precautions should be taken immediately following a loop diuretic drug change in an effort to prevent falls.
authors.affiliation: Hebrew SeniorLife Institute for Aging Research and Beth Israel Deaconess Medical Center Division of Gerontology, Boston, MA 02131, USA. sarahberry@hsl.harvard.edu
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Berry
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mostofsky
authors.forename: Dana
authors.initials: D
authors.lastname: Goldense
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D015331:Cohort Studies; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors