Effects of Potentially Inappropriate Psychoactive Medications on Falls in US Nursing Home Residents Analysis of the 2004 National Nursing Home Survey Database

Background and Objective: Use of potentially inappropriate psychoactive medications (PIPMs) poses a serious threat of falls among elderly nursing home residents. This study was conducted to identify the effects of PIPMs on falls compared with use of other psychoactive medications among elderly US nursing home residents. Methods: The 2004 National Nursing Home Survey (NNHS) was used as the data source. Logistic regression was performed to ascertain the relationship between elderly residents who fell in the past 30 days and the use of PIPMs as per Beers' criteria in the presence of other risk factors. The data analysis was performed using SAS version 9.1. Results: The 2004 NNHS database includes data concerning 11940 elderly residents in 1174 facilities. The mean age of the elderly residents was 84.1 +/- 7.97 years. Residents receiving PIPMs were at an increased risk of falling compared with those receiving other psychoactive medications (odds ratio [OR] = 0.830, p = 0.028) as well as compared with residents not receiving psychoactive medications (OR=0.624, p<0.001). In addition, residents' fall risk increased with an increase in the number of impaired activities of daily living(OR=1.160, p<0.001). Presence of depressed mood indicators was also identified as an important risk factor (OR=1.256, p<0.001). Use of bedrails had a protective effect on residents' fall risk (OR=0.714, p<0.001). Demographic factors such as male sex and White race were also significant fall-risk factors. Conclusion: Prevention of falls in elderly nursing home residents remains a challenge. Despite the recommendations of prescribing guidelines, PIPMs are still prescribed to elderly nursing home residents. Access to appropriate psychoactive medications should be ensured. Residents with the identified risk factors should be closely monitored. Further research should be pursued to evaluate the impact on falls of potentially inappropriate medications in other therapeutic categories.