Drugs may increase falls in nursing home residents

NEW YORK (Reuters Health) - Cutting down on medication, especially tranquilizers and antidepressants, and using wheelchairs and bed rails selectively, could help reduce the number of falls among nursing home residents, Swedish researchers report.

"Although freedom-restricting actions cannot eliminate falls totally, our results support the hypothesis that they might be protective when used selectively with fewer...benzodiazepines," Edit Fonad of the Karolinska Institutet in Stockholm and colleagues write.

Fonad and her team investigated risk factors for falls among residents of 21 nursing home units over a 4-year period, during which time 2,343 falls occurred.

Patients in wheelchairs were more likely to also be using bed rails, safety belts, sleeping pills and antidepressants. Those who were using bed rails were also more likely to be using safety belts and medication. Patients using safety belts were more likely to be on several different drugs.

As expected, patients who fell were more likely to suffer fractures. Patients who were given benzodiazepines to go to sleep were more likely to suffer fractures, while those on antidepressants were more likely to experience falls. However, patients in wheelchairs and those using bed rails were less likely to fall.

The findings underscore the importance of addressing fall risks on an individual basis and taking a patient's environment into account, Fonad and her team conclude.

"Physical restraints are obvious fall prevention measures," they write. "Nevertheless, the aim is to maintain the patient's autonomy and integrity, and we must remember that physical restraints can also cause injuries."

SOURCE: Journal of Clinical Nursing, January 2008.