Skip to main content
SpringerLink
Log in

Effects of Potentially Inappropriate Psychoactive Medications on Falls in US Nursing Home Residents

Analysis of the 2004 National Nursing Home Survey Database

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background and Objective: Use of potentially inappropriate psychoactive medications (PIPMs) poses a serious threat of falls among elderly nursing home residents. This study was conducted to identify the effects of PIPMs on falls compared with use of other psychoactive medications among elderly US nursing home residents.

Methods: The 2004 National Nursing Home Survey (NNHS) was used as the data source. Logistic regression was performed to ascertain the relationship between elderly residents who fell in the past 30 days and the use of PIPMs as per Beers’ criteria in the presence of other risk factors. The data analysis was performed using SAS version 9.1.

Results: The 2004 NNHS database includes data concerning 11 940 elderly residents in 1174 facilities. The mean age of the elderly residents was 84.1 ± 7.97 years. Residents receiving PIPMs were at an increased risk of falling compared with those receiving other psychoactive medications (odds ratio [OR] = 0.830, p = 0.028) as well as compared with residents not receiving psychoactive medications (OR = 0.624, p < 0.001). In addition, residents’ fall risk increased with an increase in the number of impaired activities of daily living (OR = 1.160, p < 0.001). Presence of depressed mood indicators was also identified as an important risk factor (OR = 1.256, p < 0.001). Use of bedrails had a protective effect on residents’ fall risk (OR = 0.714, p < 0.001). Demographic factors such as male sex and White race were also significant fall-risk factors.

Conclusion: Prevention of falls in elderly nursing home residents remains a challenge. Despite the recommendations of prescribing guidelines, PIPMs are still prescribed to elderly nursing home residents. Access to appropriate psychoactive medications should be ensured. Residents with the identified risk factors should be closely monitored. Further research should be pursued to evaluate the impact on falls of potentially inappropriate medications in other therapeutic categories.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Fuller GF. Falls in the elderly. Am Fam Physician 2000; 61(7): 2159–68

    PubMed  CAS  Google Scholar 

  2. Marin PP. Latin-American regional review on falls in older people [online]. Available from URL: http://www.who.int/ageing/projects/AMRO-Chile.pdf [Accessed 2007 Nov 18]

  3. Cooper JW, Freeman MH, Cook CL, et al. Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents. Consult Pharm 2007; 22(6): 483–9

    Article  PubMed  Google Scholar 

  4. Landi F, Onder G, Cesari M, et al. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A Biol Sci Med Sci 2005; 60(5): 622–6

    Article  PubMed  Google Scholar 

  5. Souchet E, Lapeyre-Mestre M, Montastruc JL. Drug related falls: a study in the French Pharmacovigilance Database. Pharmacoepidemiol Drug Saf 2005; 14(1): 11–6

    Article  PubMed  Google Scholar 

  6. US Department of Health and Human Services, National Center for Health Statistics. National Nursing Home Survey, 2004 [online]. Available from URL: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NNHS/nnhs04/ [Accessed 2007 Apr 13]

  7. US Department of Health and Human Services, National Center for Health Statistics. National Nursing Home Survey (NNHS) [online]. Available from URL: http://www.cdc.gov/nchs/nnhs.htm [Accessed 2009 Feb 1]

  8. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003; 163(22): 2716–24

    Article  PubMed  Google Scholar 

  9. Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 2004; 52(11): 1934–9

    Article  PubMed  Google Scholar 

  10. Chang CM, Liu PY, Yang YH, et al. Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients. Pharmacotherapy 2005; 25(6): 831–8

    Article  PubMed  Google Scholar 

  11. Perri 3rd M, Menon AM, Deshpande AD, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother 2005; 39(3): 405–11

    Article  PubMed  Google Scholar 

  12. National Committee for Quality Assurance. HEDIS 2008 final NDC lists [online]. Available from URL: http://www.ncqa.org/tabid/598/Default.aspx [Accessed 2008 Aug 12]

  13. Kiely DK, Kiel DP, Burrows AB, et al. Identifying nursing home residents at risk for falling. J Am Geriatr Soc 1998; 46(5): 551–5

    PubMed  CAS  Google Scholar 

  14. Cigolle CT, Langa KM, Kabeto MU, et al. Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med 2007; 147(3): 156–64

    PubMed  Google Scholar 

  15. Van DC, Gruber-Baldini AL, Zimmerman S. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003; 51(9): 1213–8

    Article  Google Scholar 

  16. Lowery K, Buri H, Ballard C. What is the prevalence of environmental hazards in the homes of dementia sufferers and are they associated with falls? Int J Geriatr Psychiatry 2000; 15(10): 883–6

    Article  PubMed  CAS  Google Scholar 

  17. Capezuti E, Strumpf NE, Evans LK, et al. The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci 1998; 53A(1): M47–52

    Article  Google Scholar 

  18. Tinetti ME, Wen-Liang L, Ginter SF. Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med 1992; 116(5): 369–74

    PubMed  CAS  Google Scholar 

  19. French DD, Werner DC, Campbell RR, et al. A multivariate fall risk assessment model for VHA nursing homes using the minimum data set. J Am Med Dir Assoc 2007; 8(2): 115–22

    Article  PubMed  Google Scholar 

  20. Kose N, Cuvalci S, Ekici G, et al. The risk factors of fall and their correlation with balance, depression, cognitive impairment and mobility skills in elderly nursing home residents. Saudi Med J 2005; 26(6): 978–81

    PubMed  Google Scholar 

  21. Jantti PO, Pyykko I, Laippala P. Prognosis of falls among elderly nursing home residents. Aging (Milano) 1995; 7(1): 23–7

    CAS  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the contents of this study.

Author information

Authors and Affiliations

  1. St John’s University, Queens, New York, USA

    Neetu Agashivala &  Wenchen K. Wu

Authors
  1. Neetu Agashivala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenchen K. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Neetu Agashivala or Wenchen K. Wu.

Appendix

Appendix

List of PIPMs as per Beers’ criteria[8] and ICD-9 codes 0626–0635:

  • Flurazepam

  • Amitriptyline

  • Chlordiazepoxide/amitriptyline

  • Perphenazine/amitriptyline

  • Doxepin

  • Meprobamate

  • Lorazepam

  • Oxazepam

  • Alprazolam

  • Temazepam

  • Triazolam

  • Chlordiazepoxide

  • Clidinium/chlordiazepoxide

  • Diazepam

  • Quazepam

  • Halazepam

  • Chlorazepate

  • Hydroxyzine

  • Amphetamines and anorexic agents

  • Daily fluoxetine

  • Thioridazine

  • Mesoridazine.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Agashivala, N., Wu, W.K. Effects of Potentially Inappropriate Psychoactive Medications on Falls in US Nursing Home Residents. Drugs Aging 26, 853–860 (2009). https://doi.org/10.2165/11316800-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11316800-000000000-00000

Keywords

Search

Navigation