Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-Centre study
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PURPOSE: Falls and polypharmacy are both common in care home residents. Deprescribing of medications in residents with increased falls risk is encouraged. Psychotropic medications are known to increase falls risk in older adults. These drugs are often used in care home residents for depression, anxiety, and behavioural and psychological symptoms of dementia. However, a few studies have explored the link between polypharmacy, psychotropic medications, and falls risk in care home residents. METHODS: This was a prospective cohort study of residents from 84 UK care homes. Data were collected from residents' care records and medication administration records. Age, diagnoses, gender, number of medications, and number of psychotropic medications were collected at baseline and residents were monitored over three months for occurrence of falls. Logistic regression models were used to assess the effect of multiple medications and psychotropic medication on falls whilst adjusting for confounders. RESULTS: Of the 1655 participants, mean age 85 (SD 8.9) years, 67.9% female, 519 (31%) fell in 3 months. Both the total number of regular drugs prescribed and taking ≥ 1 regular psychotropic medication were independent risk factors for falling (adjusted odds ratio (OR) 1.06 (95% CI 1.03-1.09, p < 0.01) and 1.39 (95% CI 1.10-1.76, p < 0.01), respectively). The risk of falls was higher in those taking antidepressants (p < 0.01) and benzodiazepines (p < 0.01) but not antipsychotics (p > 0.05). CONCLUSION: In UK care homes, number of medications and psychotropic medications (particularly antidepressants and benzodiazepines) predicted falls. This information can be used to inform prescribing and deprescribing decisions.
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In older adults, psychotropic use has been associated with risk of severe adverse effects such as falls, stroke and mortality.
“In older adults, psychotropic use has been associated with the risk of severe adverse effects such as falls [13–18], stroke [17, 19–22] and mortality [13, 23–25].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [14]
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- Authors
- Izza, M. A. D., Lunt, E., Gordon, A. L., Gladman, J. R. F., Armstrong, S., & Logan, P.
- Affiliations
- University of Nottingham (GB)
- Corresponding author
- Izza, Madeline A. D.
- Venue
- European Geriatric Medicine
- Published
- 2020-08-19
- Volume
- 11
- Issue
- 6
- Pages
- 1043-1050
- ISSN
- 1878-7649 (ISSN-L)
- 1878-7657
- PMC
- PMC7716922
- OpenAlex
- W3075598621
- Cited by
- 48
- References
- 24
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 7 · 2023: 13 · 2022: 8 · 2021: 13
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Geriatric Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research (13/115/29)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- polypharmacy, fall risk, benzodiazepines, antidepressants, antipsychotic drugs, psychotropic drugs, nursing home residents, older adults, deprescribing, drug prescribing
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Antidepressive Agents, Benzodiazepines, Female, United Kingdom, Homes for the Aged, Humans, Infant, Male, Prospective Studies, Antipsychotic Agents, Polypharmacy
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