Psychotropic drugs increase fall risk

📖 Literature Information and Abstract Translation

A longitudinal study of the use and effects of fall-risk-increasing drugs in residential aged care

[Background/Objective] Psychotropic drugs and cardiovascular disease (CVD) drugs, which are fall-risk-increasing drugs (FRIDs), may increase the risk of falls. While strong evidence has been observed for psychotropic FRIDs, the evidence for CVD FRIDs remains inconclusive. Existing research on FRIDs and falls is often hindered by methodological limitations. This study aimed to utilize longitudinal observational data to clarify the association between long-term use patterns of FRIDs and falls in residential aged care (RAC) facilities.

[Methods] Study design: Retrospective longitudinal cohort study. Subjects and setting: A total of 4,207 newly admitted permanent residents in 27 residential aged care facilities in Sydney, Australia. Methods: The incidence of falls and injurious falls was investigated. Exposure to each FRID was measured over 60 months using the Proportion of Days Covered (PDC) metric. Group-based multi-trajectory modeling was used to identify concurrent use patterns of psychotropic and cardiovascular FRIDs, and negative binomial regression was applied to evaluate the association with falls.

[Results] A total of 83.6% (n=3516) and 77.3% (n=3254) of residents used psychotropic and cardiovascular drugs, respectively.
PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropic drugs, and from 79.0% (alpha-adrenoceptor antagonists) to 89.6% (beta-blockers) for cardiovascular drugs. Four groups were identified. Group 1 had low psychotropic and low cardiovascular drug use (16.7%, n=701). Group 2 had low psychotropic and high cardiovascular drug use (25.0%, n=1054), Group 3 (high psychotropic-high cardiovascular, 41.0%, n=1723), and Group 4 (high psychotropic-low cardiovascular, 17.3%, n=729).
The group with high psychotropic and low cardiovascular drug use (Group 4) showed the highest fall rate (e.g., IRR 1.86 [95% CI: 1.61–2.15] for all falls). On the other hand, the group with low psychotropic and high cardiovascular drug use (Group 2) showed no significant difference in fall rate compared to the reference group (Group 1) (IRR 0.96 [95% CI: 0.80–1.14]).

[Conclusion] Our findings reveal a very high prevalence of FRID use in aged care facilities and highlight significant differences in the impact of the two main FRID classes on falls. Psychotropic drugs were strongly associated with falls, whereas the CVD FRIDs investigated did not increase the risk of falls.

🌱 So What?: What did I find interesting?

I knew that medications increase the risk of falls.
However, when asked which medications require particular caution, I had only been thinking of them in parallel.
This literature review investigated the association between fall risk and two types of drugs known as FRIDs: psychotropic drugs and cardiovascular drugs.
As a result, the negative impact of psychotropic drugs on falls was highlighted, rather than cardiovascular drugs.

Moving forward, I want to pay particular attention to psychotropic drugs among FRIDs.
If there is a patient taking psychotropic drugs, I would like to share information with nurses and take measures such as slightly raising the threshold for judging independence.

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