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Open Access Highly Accessed Research article

Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care

Veronica Milos16*, Åsa Bondesson23, Martina Magnusson4, Ulf Jakobsson1, Tommy Westerlund5 and Patrik Midlöv1

Author Affiliations

1 Center for Primary Health Care Research, Institution of Clinical Sciences, Lund University, Lund, Sweden

2 Department of Medicines Management and Informatics, Region Skåne, Sweden

3 Clinical Pharmacology, Department of Laboratory Medicine, Lund University, Lund, Sweden

4 University of Gothenburg, Gothenburg, Sweden

5 Medical Products Agency, Department of Usage Uppsala, and Sahlgrenska Academy, Institute of Medicine, Department of Public Health and Community Medicine, Unit of Social Medicine, University of Gothenburg, Gothenburg, Sweden

6 Department of General Medicine, Center for Primary Health Care Research, Institution of Clinical Sciences, Lund University, Malmö Clinical Research Centre (CRC), building 28, floor 11 Jan Waldenströms gata 35, Skåne University Hospital, 205 02 Malmö, Sweden

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BMC Geriatrics 2014, 14:40  doi:10.1186/1471-2318-14-40

Published: 27 March 2014

Abstract

Background

Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged ≥75 years and who were using a multi-dose drug dispensing system.

Methods

Data were collected from the patients’ electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers.

Results

The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs.

Conclusions

Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.

Keywords:
Elderly; Falls; Prevention; Drug therapy; Fall risk-increasing drugs