Open Access Highly Accessed Research article

Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?

Federico Baranzini1, Marcello Diurni1, Francesca Ceccon1, Nicola Poloni1, Sara Cazzamalli1, Chiara Costantini1, Cristiano Colli2, Laura Greco2 and Camilla Callegari1*

Author Affiliations

1 Dipartimento di Medicina Clinica, Università degli Studi dell'Insubria, Via O Rossi 9, 21100 Varese, Italy

2 Residenza Sanitaria Assistenziale (RSA) Fondazione Fratelli Molina, V le Borri, 21100 Varese, Italy

For all author emails, please log on.

BMC Health Services Research 2009, 9:228  doi:10.1186/1472-6963-9-228

Published: 11 December 2009



Polypharmacy is regarded as an important risk factor for fallingand several studies and meta-analyses have shown an increased fall risk in users of diuretics, type 1a antiarrhythmics, digoxin and psychotropic agents. In particular, recent evidence has shown that fall risk is associated with the use of polypharmacy regimens that include at least one established fall risk-increasing drug, rather than with polypharmacy per se. We studied the role of polypharmacy and the role of well-known fall risk-increasing drugs on the incidence of injurious falls.


A retrospective observational study was carried out in a population of elderly nursing home residents. An unmatched, post-stratification design for age class, gender and length of stay was adopted. In all, 695 falls were recorded in 293 residents.


221 residents (75.4%) were female and 72 (24.6%) male, and 133 (45.4%) were recurrent fallers. 152 residents sustained no injuries when they fell, whereas injuries were sustained by 141: minor in 95 (67.4%) and major in 46 (32.6%). Only fall dynamics (p = 0.013) and drugs interaction between antiarrhythmic or antiparkinson class and polypharmacy regimen (≥7 medications) seem to represent a risk association for injuries (p = 0.024; OR = 4.4; CI 95% 1.21 - 15.36).


This work reinforces the importance of routine medication reviews, especially in residents exposed to polypharmacy regimens that include antiarrhythmics or antiparkinson drugs, in order to reduce the risk of fall-related injuries during nursing home stays.