Background Falls are a major cause of morbidity in older people, and a matter of concern in hospitals and long term care settings. Drugs may contribute to an increase in the risk of falling in these patients.
Purpose To identify drug related risk factors associated with falls during hospital stay in older adults admitted to a medium stay hospital with an electronic error and adverse event reporting system.
Material and methods This was a retrospective observational study of all patients admitted to our hospital in November 2015. Demographics and medication data were collected from electronic medical records, and falls were registered with an electronic incidence reporting system. Errors and adverse events related to care were reported by all health professionals of the hospital, and were analysed by the pharmacists. We assessed the incidence of falls in different groups regarding drug related variables: polypharmacy (≥5 chronic medications), hyperpolypharmacy (≥10), anticholinergic burden measured with the anticholinergic risk score (ARS) and STOPP criteria section K (drugs that predictably increase the risk of falls: benzodiazepines and neuroleptics).
Results 96 patients were included, mean age 82.3 years (SD=7.6); 66 (68.8%) were women. Mean length of hospital stay was 25.9 days (SD=11). 15 falls were reported (15.6% of patients); 5 of 33 patients from the convalescence unit (15.2%), 6/48 from the rehabilitation unit (12.5%) and 4/15 from the psychogeriatry unit (26.7%). Polymedicated patients fell more than non-polymedicated (13/74 (17.6%) vs 2/22 (9.1%) (p=0.508)) and also those with hyperpolypharmacy (7/29 (24.1%) vs 8/67 (11.9%) (p=0.131)). There were more falls in those with higher anticholinergic risk: low risk (ARS=0) 5 falls in 49 patients (10.2%); medium risk (ARS=1–2) 7/39 (17.9%); high risk (ARS ≥3) 3/8 (37.5%) (p=0.105). Patients taking benzodiazepines experienced more falls (11/62 (17.7%) vs 4/34 (11.8%) (p=0.440)) and also those taking neuroleptic drugs (5/23 (21.7%) vs 70/73 (13.7%) (p=0.354)). Statistical significance was not reached.
Conclusion Polypharmacy, anticholinergic burden and STOPP criteria may be associated with a higher incidence of falls in older people admitted to a medium stay hospital. It is important to address the risk of falling in these patients according to their medications, and electronic incidence reporting tools can allow assessment of the risk and initiate interventions.
No conflict of interest
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