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The influence of drug use on fall incidents among nursing home residents: a systematic review

Published online by Cambridge University Press:  17 April 2008

Carolyn S. Sterke ,
Arianne P. Verhagen ,
Ed F. van Beeck  and
Tischa J. M. van der Cammen
Carolyn S. Sterke
Affiliation:
De StromenOpmaatGroep, Nursing Home Smeetsland, Rotterdam, the Netherlands Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, the Netherlands
Arianne P. Verhagen
Affiliation:
Department of General Practice, Erasmus University Medical Center Rotterdam, the Netherlands
Ed F. van Beeck
Affiliation:
Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands
Tischa J. M. van der Cammen*
Affiliation:
Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center Rotterdam, the Netherlands
*
Correspondence should be addressed to: Dr Tischa J. M. van der Cammen, Associate Professor of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Room D442, PO Box 2040, NL-3000 CA Rotterdam, The Netherlands. Phone: +31 (0)10 703.59.79; Fax: +31 (0)10 703.47.68. Email: t.vandercammen@erasmusmc.nl.
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Abstract

Background: Falls are a major health problem among the elderly, particularly in nursing homes. Abnormalities of balance and gait, psychoactive drug use, and dementia have been shown to contribute to fall risk.

Methods: We conducted a systematic review of the literature to investigate which psychoactive drugs increase fall risk and what is known about the influence of these drugs on gait in nursing home residents with dementia. We included studies with a prospective cohort design on psychoactive drug use in nursing homes with dementia residents and with falls as an outcome measure.

Results: Seventeen studies were included in the review. Pooled risk estimates were not calculated because there was no homogeneity across studies. We assessed the strength of evidence for psychoactive drugs as a prognostic factor for falls by defining four levels of evidence: strong, moderate, limited or inconclusive. Strong evidence was defined as consistent findings (≥80%) in at least two high quality cohorts. We found strong evidence that the use of multiple drugs (3/3 cohorts, effect sizes 1.30–1xs0.30), antidepressants (10/12 cohorts, effect sizes 1.10–7.60), and anti-anxiety drugs (2/2 cohorts, effect sizes 1.22–1.32) is associated with increased fall risk. The evidence for the association of other psychoactive drug classes with fall risk was limited or inconclusive.

Conclusions: Research on the contribution of psychoactive drugs to fall risk in nursing home residents with dementia is limited. The scarce evidence shows, however, that multiple drugs, antidepressants and anti-anxiety drugs increase fall risk in nursing home populations with residents with dementia.

Keywords

fallsgaitpsychoactive drugsdementianursing homes
Type
Review Article
Information
International Psychogeriatrics , Volume 20 , Issue 5 , October 2008 , pp. 890 - 910
Copyright
Copyright © International Psychogeriatric Association 2008

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