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American Journal of Health-System Pharmacy, Vol. 67, Issue 15, 1274-1280
Copyright © 2010 by American Society of Health-System Pharmacists
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Clinical Report

Influence of medications and diagnoses on fall risk in psychiatric inpatients

 Stacey M. Lavsa, Tanya J. Fabian, Melissa I. Saul, Shelby L. Corman and Kim C. Coley

STACEY M. LAVSA, PHARM.D., is Clinical Pharmacist, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA. TANYA J. FABIAN, PHARM.D., PH.D., BCPP, is Assistant Professor of Pharmacy and Therapeutics and Psychiatry, Schools of Pharmacy and Medicine, University of Pittsburgh (UP), Pittsburgh, and Director of Pharmacy Research and Pharmacy Services, Western Psychiatric Institute and Clinic, UPMC. MELISSA I. SAUL, M.S., is Director of Clinical Research Informatics Services, School of Medicine, UP. SHELBY L. CORMAN, PHARM.D., BCPS, is Assistant Professor of Pharmacy and Therapeutics, School of Pharmacy, UP, and Clinical Specialist, Drug Information, UPMC. KIM C. COLEY, PHARM.D., FCCP, is Professor of Pharmacy and Therapeutics, School of Pharmacy, UP

Address correspondence to Dr. Coley at the School of Pharmacy, University of Pittsburgh, 921 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261 (coley{at}pitt.edu).


Purpose. The influence of medications and diagnoses on fall risk in psychiatric inpatients was evaluated.

Methods. In this retrospective case–control study, psychiatric inpatients age 18 years or older with a documented fall that was reported served as study cases. These patients were matched to control patients from the same hospital (1:1) by admission year, sex, and age. Psychiatric diagnoses evaluated included major depressive disorder, schizophrenia or schizoaffective disorder, bipolar disorder, Alzheimer’s disease and dementia, anxiety or neurosis, delirium, personality disorder, and obsessive-compulsive disorder. Medications assessed as independent variables were conventional antipsychotics, atypical antipsychotics, selective serotonin-reuptake inhibitors, tricyclic antidepressants, atypical antidepressants, monoamine oxidase inhibitors, lithium, anticonvulsants, benzodiazepines, nonbenzodiazepine sleep aids, Alzheimer’s disease medications, antihistamines, antiarrhythmics, antihypertensives, benign prostatic hyperplasia medications, oral hypoglycemic agents, histamine H2-receptor blockers, laxatives and stool softeners, muscle relaxants, nonsteroidal antiinflammatory drugs, opioids, Parkinson’s disease medications, and overactive bladder medications. Univariate logistic regression models were developed for each risk factor to determine its impact on fall risk.

Results. A total of 774 patient cases were matched with controls. Most falls occurred on the second day of hospitalization. Medications associated with a higher risk of falls were {alpha}-blockers, nonbenzodiazepine sleep aids, benzodiazepines, H2-blockers, lithium, antipsychotics, atypical antidepressants, anticonvulsants, and laxatives and stool softeners. Patients with a diagnosis of dementia and Alzheimer’s disease also had an increased risk of falling.

Conclusion. Alpha-blockers, nonbenzodiazepine sleep aids, benzodiazepines, H2-blockers, lithium, atypical antipsychotics, atypical antidepressants, anticonvulsants and mood stabilizers, conventional anti-psychotics, laxatives and stool softeners, and dementia and Alzheimer’s disease were significant predictors of inpatient falls in a psychiatric population.

Index terms: Accidental falls; Alzheimer disease; Anticonvulsants; Antidepressants; Antimanic agents; Antipsychotic agents; Anxiolytics; sedatives and hypnotics; Benzodiazepines; Dementia; Gastrointestinal drugs; Laxatives and cathartics; Lithium; Mental disorders; Patients; Sympatholytic agents; Toxicity

 

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