title: Antipsychotic and Benzodiazepine Drug Changes Affect Acute Falls Risk Differently in the Nursing Home.
abstract: BACKGROUND
  Psychotropic drugs increase the risk of falls, but they are still frequently prescribed to treat behavioral symptoms associated with dementia in the nursing home. We examined whether there is an acute increased risk of falls in the days following a change to an antipsychotic or benzodiazepine drug prescription.
  
  
  METHODS
  We collected information on 594 long-stay nursing home residents from two facilities who fell at least once between September 1, 2010 and May 31, 2013. Psychotropic drug changes were ascertained from the facilities' computerized medication administration log. We used the case-crossover design to compare the frequency of antipsychotic and benzodiazepine drug changes during the days before a fall with the frequency of drug changes at more remote times.
  
  
  RESULTS
  Mean age was 87.5 years, and 75.1% were female. The risk of falls was higher in the 24 hours following benzodiazepine initiation compared with other times (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.10, 13.00). There was no clear difference in risk following antipsychotic initiation (OR 2.42, CI 0.58, 10.06), but this could be due to the small sample size. Stopping a benzodiazepine was associated with a significantly reduced fall risk (OR 0.26, 95% CI 0.08-0.91).
  
  
  CONCLUSIONS
  Benzodiazepines pose an immediate threat to fall risk, whereas it is less clear if antipsychotics also pose an immediate risk. Nursing home staff should be particularly vigilant in the days following the new prescription for a benzodiazepine in an effort to prevent injury.
authors.affiliation: Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts. SarahBerry@hsl.harvard.edu.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Berry
authors.affiliation: Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Placide
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center Cardiovascular Epidemiology Research Unit, Boston, Massachusetts.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mostofsky
authors.affiliation: Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center Cardiovascular Epidemiology Research Unit, Boston, Massachusetts.
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.affiliation: Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines
keywords: Antipsychotic; Benzodiazepine; Drug change; Falls; Nursing home