title: Association between use of multiple psychoactive medicines and hospitalization for falls: retrospective analysis of a large healthcare claim database.
abstract: BACKGROUND
  Little is known about the impact of taking multiple psychoactive medicines on the risk of hospitalization for falls.
  
  
  OBJECTIVE
  To identify the association between multiple psychoactive medicine use and hospitalization for falls.
  
  
  METHODS
  A retrospective cohort study was conducted between July 2011 and June 2012 in the Australian veteran population who had been dispensed at least one psychoactive medicine within the previous year. Psychoactive medicines with sedative properties included antipsychotics, anxiolytics, hypnotics, antidepressants, opioids, anti-epileptics, anti-Parkinson medicines and medicines for migraine. The associations between falls and the number of psychoactive medicines used or the number of doses were analysed in comparison with falls that occurred when no psychoactive medicine was used.
  
  
  RESULTS
  The adjusted results showed a significantly increased risk of falls when patients were on one or more psychoactive medicines or were receiving 0.1-0.9 defined daily dose (DDD) or more per day. The incident rate ratios (IRRs) were 1.22 (95% confidence interval [CI] 1.08-1.38) for those on one psychoactive medicine, 1.70 (95% CI 1.45-1.99) for those on two, 1.96 (95% CI 1.58-2.43) for those on three or four, and 3.15 (95% CI 1.90-5.23) for those on five or more. A similar result was observed when the data were analysed by dose, with the highest risk being found for those taking three or more DDD per day (adjusted IRR 4.26, 95% CI 2.75-6.58).
  
  
  CONCLUSIONS
  Increased numbers or increased doses of psychoactive medicines are associated with an increased risk of hospitalization for falls in older adults. Strategies to reduce the psychoactive medicine burden are likely to translate into significant health benefits.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5001, Australia.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
authors.forename: Emmae N
authors.initials: EN
authors.lastname: Ramsay
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kalisch Ellett
authors.forename: Tuan A
authors.initials: TA
authors.lastname: Nguyen
authors.forename: John D
authors.initials: JD
authors.lastname: Barratt
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D014728:Veterans
chemical_list: D011619:Psychotropic Drugs