title: Psychotropic medications and falls in nursing homes: a cross-sectional study.
abstract: BACKGROUND
  Psychotropic medications are very frequently used in nursing homes and have been associated with falls. Little is known on the potential differences between types and subtypes of these medications, and also regarding different prescription patterns.
  
  
  METHODS
  Data from 4502 residents living in 41 nursing homes belonging to a Spanish private chain were collected during a study period of 1 month and analyzed. Frequency of injurious and noninjurious falls were investigated for the following groups of psychotropic medications: typical neuroleptics; atypical neuroleptics; antidepressants; short and middle half-life benzodiazepines (BZD); long half-life BZD; BZD (of any type) administered only if needed; other hypnotic, sedative or anxiolytic drugs; cholinesterase inhibitors, and memantine. OR (95% CI) were calculated using regression analysis adjusted for age, sex, number of medications, physical restraint, and cognitive performance.
  
  
  RESULTS
  Mean age (SD) was 84.3 (8.6) and 73.4% of the subjects were female. Psychotropic medication was prescribed to 2987 residents (66.3%), and there were 490 falls. Total falls were associated with use of atypical neuroleptics (OR 1.50, CI 1.17‒1.94), antidepressants (OR 1.36, CI 1.03‒1.78), short and middle half-life BZD (OR 1.27, CI 1.00‒1.60), long half-life BZD (OR 1.65, CI 1.14‒2.38), cholinesterase inhibitors (OR 1.42, CI 1.05‒1.92), and memantine (OR 1.90, CI 1.32‒2.74). Injurious falls were associated with typical neuroleptics (OR 1.77, CI 0.99‒3.17), atypical neuroleptics (OR 1.64, CI 1.11‒2.44), and long half-life BZD (OR 2.57, CI 1.56‒4.25). The use of 2 or more psychotropics in combination was also associated with a significant increase of total falls and injurious falls.
  
  
  CONCLUSIONS
  Psychotropic medications were highly prescribed in the studied sample and were associated with falls. The most unsafe profile was detected for long half-life BZD, neuroleptics, and psychotropics in combination.
authors.affiliation: Maria Wolff Foundation, Madrid, Spain. javier@mariawolff.es
authors.forename: Javier
authors.initials: J
authors.lastname: Olazarán
authors.forename: Daniel
authors.initials: D
authors.lastname: Valle
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Serra
authors.forename: Pedro
authors.initials: P
authors.lastname: Cano
authors.forename: Ruben
authors.initials: R
authors.lastname: Muñiz
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D013030:Spain
chemical_list: D011619:Psychotropic Drugs