International Journal of Clinical Pharmacy

, Volume 39, Issue 2, pp 408–415 | Cite as

Medication use and risk of falls among nursing home residents: a retrospective cohort study

  • Andrea Bor
  • Mária Matuz
  • Márta Csatordai
  • Gábor Szalai
  • András Bálint
  • Ria Benkő
  • Gyöngyvér Soós
  • Péter DoróEmail author
Research Article


Background Geriatric falls are leading causes of hospital trauma admissions and injury-related deaths. Medication use is a crucial element among extrinsic risk factors for falls. To reduce fall risk and the prevalence of adverse drug reactions, potentially inappropriate medication (PIM) lists are widely used. Objective Our aim was to investigate the possible predictors of geriatric falls annualized over a 5-year-long period, as well as to evaluate the medication use of nursing home residents. Setting Nursing home residents were recruited from the same institution between 2010 and 2015 in Szeged, Hungary. Method A retrospective epidemiological study was performed. Patient data were analysed for the first 12 months of residency. Chi-squared test and Fisher’s-test were applied to compare the categorical variables, Student’s t test to compare the continuous variables between groups. Binary logistic regression analysis was carried out to determine the association of falls with other variables found significant in univariate analysis. Microsoft Excel, IBM SPSS Statistics (version 23) and R (3.2.2) programs were used for data analysis. Main outcome measure Falls affected by age, gender, number of chronic medications, polypharmacy, PIM meds. Results A total of 197 nursing home residents were included, 150 (76.2%) women and 47 (23.8%) men, 55 fallers (annual fall prevalence rate was 27.9%) and 142 non-fallers. Gender was not a predisposing factor for falls (prevalence in males: 23.4 vs 29.3% in females, p > 0.05). Fallers were older (mean years ± SD; 84.0 ± 7.0) than non-fallers (80.1 ± 9.3, p < 0.01). The age ≥80 years was a significant risk factor for falls (p < 0.001). The number of chronic medications was higher in male fallers (12.4 ± 4.0) than in non-fallers (6.9 ± 4.2, p < 0.001). Polypharmacy (taking four or more chronic medications) was a significant risk factor of falls (p < 0.01). Those PIMs carrying fall risk were taken by 70.9% of fallers and 75.3% of non-fallers (p > 0.05). Taking pantoprazole, vinpocetine or trimetazidine was a significant risk factor for falls. Conclusion Older age, polypharmacy and the independent use of pantoprazole, vinpocetine, and trimetazidine were found to be major risk factors for falls. Further real-life epidemiological studies are necessary to confirm the role of particular active agents, and to help professionals prescribe, evaluate and review geriatric medication use.


Elderly Fall risk Hungary Nursing home Polypharmacy Potentially inappropriate medication 




Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Centers for Disease Control and Prevention Falls in Nursing Homes. Updated 2015 June 30. Accessed 2 Feb 2016.
  2. 2.
    World Health Organization Global Report on Falls Prevention in Older Age. 2007. Accessed 22 Jan 2016.
  3. 3.
    Ambrose AF, Cruz L, Paul G. Falls and fractures: a systematic approach to screening and prevention. Maturitas. 2015;82:85–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res. 2011;469:1900–5.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bor A, Matuz M, Gyimesi N, Biczok Z, Soos G, Doro P. Gender inequalities in the treatment of osteoporosis. Maturitas. 2015;80:162–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Freeland KN, Thompson AN, Zhao Y, Leal JE, Mauldin PD, Moran WP. Medication use and associated risk of falling in a geriatric outpatient population. Ann Pharmacother. 2012;46:1188–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Wu TY, Chie WC, Yang RS, Liu JP, Kuo KL, Wong WK, et al. Factors associated with falls among community-dwelling older people in Taiwan. Ann Acad Med Singap. 2013;42:320–7.PubMedGoogle Scholar
  9. 9.
    Weber V, White A, McIlvried R. An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population. J Gen Intern Med. 2008;23:399–404.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Willeboordse F, Grundeken LH, van den Eijkel LP, Schellevis FG, Elders PJ, Hugtenburg JG. Information on actual medication use and drug-related problems in older patients: questionnaire or interview? Int J Clin Pharm. 2016;38:380–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Chau SH, Jansen AP, van de Ven PM, Hoogland P, Elders PJ, Hugtenburg JG. Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. Int J Clin Pharm. 2016;38:46–53.CrossRefPubMedGoogle Scholar
  12. 12.
    Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61:218–23.CrossRefPubMedGoogle Scholar
  13. 13.
    Zia A, Kamaruzzaman SB, Tan MP. Polypharmacy and falls in older people: balancing evidence-based medicine against falls risk. Postgrad Med. 2015;127:330–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Fialova D, Topinkova E, Gambassi G, Finne-Soveri H, Jonsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;293:1348–58.CrossRefPubMedGoogle Scholar
  16. 16.
    Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC. Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151:1825–32.CrossRefPubMedGoogle Scholar
  17. 17.
    American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;2015(63):2227–46.Google Scholar
  18. 18.
    Mercaldo ND, Lau KF, Zhou XH. Confidence intervals for predictive values with an emphasis to case-control studies. Stat Med. 2007;26:2170–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Altman DG, Bland JM. Diagnostic tests 2: predictive values. BMJ. 1994;309:102.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Agresti A. Categorical Data Analysis. 2nd ed. New York: Wiley; 2002.CrossRefGoogle Scholar
  21. 21.
    Agresti A, Caffo B. Simple and effective confidence intervals for proportions and difference of proportions result from adding two successes and two failures. Am Stat. 2000;54:280–8.Google Scholar
  22. 22.
    Laroche ML, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol. 2007;63:725–31.CrossRefPubMedGoogle Scholar
  23. 23.
    Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107:543–51.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Mann E, Bohmdorfer B, Fruhwald T, Roller-Wirnsberger RE, Dovjak P, Duckelmann-Hofer C, et al. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr. 2012;124:160–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Bjerrum L, Rosholm JU, Hallas J, Kragstrup J. Methods for estimating the occurrence of polypharmacy by means of a prescription database. Eur J Clin Pharmacol. 1997;53:7–11.CrossRefPubMedGoogle Scholar
  26. 26.
    Rubenstein LZ. Preventing falls in the nursing home. JAMA. 1997;278:595–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Stevens JA. Falls among older adults-risk factors and prevention strategies. J Safety Res. 2005;36:409–11.CrossRefPubMedGoogle Scholar
  28. 28.
    Centers for Disease Control and Prevention (CDC). Fatalities and injuries from falls among older adults–United States, 1993–2003 and 2001–2005. MMWR Morb Mortal Wkly Rep. 2006;55:1221–1224.Google Scholar
  29. 29.
    Laurent M, Gielen E, Claessens F, Boonen S, Vanderschueren D. Osteoporosis in older men: recent advances in pathophysiology and treatment. Best Pract Res Clin Endocrinol Metab. 2013;27:527–39.CrossRefPubMedGoogle Scholar
  30. 30.
    Gielen E, Vanderschueren D, Callewaert F, Boonen S. Osteoporosis in men. Best Pract Res Clin Endocrinol Metab. 2011;25:321–35.CrossRefPubMedGoogle Scholar
  31. 31.
    Fonad E, Wahlin TB, Winblad B, Emami A, Sandmark H. Falls and fall risk among nursing home residents. J Clin Nurs. 2008;17:126–34.CrossRefPubMedGoogle Scholar
  32. 32.
    Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37–41.PubMedGoogle Scholar
  33. 33.
    Russell M, Clapperton A, Vu T, Day L. Trends in fall-related hospitalisations in older people living in aged care facilities. Osteoporos Int. 2015;26:1219–24.CrossRefPubMedGoogle Scholar
  34. 34.
    Pantoprazole Summary of Product Characteristics. Accessed 23 Feb 2016.
  35. 35.
    Ozdil K, Kahraman R, Sahin A, Calhan T, Gozden EH, Akyuz U, et al. Bone density in proton pump inhibitors users: a prospective study. Rheumatol Int. 2013;33:2255–60.CrossRefPubMedGoogle Scholar
  36. 36.
    Vinpocetine Summary of Product Characteristics. Accessed 24 Feb 2016.
  37. 37.
    Trimetazidine Summary of Product Characteristics. Accessed 24 Feb 2016.
  38. 38.
    European Medicines Agency Recommendation on restricted use of trime-tazidine-containing medicines. 2012. Accessed 24 Feb 2016.
  39. 39.
    Bor A, Matuz M, Doro P, Viola R, Soos G. Drug-related problems in the elderly. Orv Hetil. 2012;153:1926–36.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyUniversity of SzegedSzegedHungary
  2. 2.Ősz Nursing Home of SzegedSzegedHungary

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