Medications and Falls – Abstracts

This document contains all abstracts for publications relating to fractures and head injuries from October 2019 through to December 2019. These abstracts have been sourced from and include only those relevant to falls prevention.

SafetyLit provides weekly abstracts of peer reviewed articles from researchers who work in the more than 30 distinct professional disciplines relevant to preventing and researching unintentional injuries, violence, and self-harm. Each week citations and summaries of about 400 articles and reports are included in a PDF document or through an RSS subscription.

Medications Q4 2019

Medications Q1 2020

Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: conditional effect of age
Cordovilla-Guardia S, Molina TB, Franco-Antonio C, Santano-Mogena E, Vilar-López R. PLoS One 2020; 15(1): e0227696.
Andalusian Observatory on Drugs and Addictions, Granada, Spain.
(Copyright © 2020, Public Library of Science)
DOI 10.1371/journal.pone.0227696 PMID 31940406
INTRODUCTION: The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship.

METHOD: From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied.

RESULTS: A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40-2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age.

CONCLUSIONS: The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.
Language: en


The risk of head injuries associated with antipsychotic use among persons with Alzheimer’s disease
Tapiainen V, Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. J. Am. Geriatr. Soc. 2020; ePub(ePub): ePub.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
(Copyright © 2020, John Wiley and Sons)
DOI 10.1111/jgs.16275 PMID 31912482
BACKGROUND/OBJECTIVES: Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer’s disease (AD).

DESIGN: Nationwide register-based cohort study. SETTING: Medication Use and Alzheimer’s Disease (MEDALZ) cohort, Finland. PARTICIPANTS: The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded.

MEASUREMENTS: Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD-10] codes S00-S09) and traumatic brain injuries (TBIs; ICD-10 codes S06.0-S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.

RESULTS: Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person-years = 1.65 [95% confidence interval {CI} = 1.50-1.81] for users and 1.26 [95% CI = 1.16-1.37] for nonusers; IPT-weighted hazard ratio [HR] = 1.29 [95% CI = 1.14-1.47]) and TBIs (event rate per 100 person-years = 0.90 [95% CI = 0.79-1.02] for users and 0.72 [95% CI = 0.65-0.81] for nonusers; IPT-weighted HR = 1.22 [95% CI = 1.03-1.45]). Quetiapine users had higher risk of TBIs (IPT-weighted HR = 1.60 [95% CI = 1.15-2.22]) in comparison to risperidone users.

CONCLUSIONS: These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies.
Language: en

Alzheimer’s disease; antipsychotics; dementia; risk factors; traumatic brain injury


Pharmacy students’ ability to identify fall risk-increasing drugs using an innovative assessment tool
Wahler RG, Piccione C, Maerten-Rivera J. Am. J. Pharm. Educ. 2019; 83(10): e7461.
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York.
(Copyright © 2019, American Association of Colleges of Pharmacy)
DOI 10.5688/ajpe7461 PMID 32001880
Objective. To evaluate change in the ability of third-year pharmacy students to identify drugs that increase fall risk after training in and experience using the Medication Falls Risk Assessment Tool (MFRAT). Methods. An assessment was administered to students prior to MFRAT use and after MFRAT use. The assessment consisted of 10 medication regimens for various chronic conditions (50 distinct drug choices with 30 correct answers and 20 distractors), and students were to identify fall risk increasing drugs (FRIDs). Using a flipped-classroom approach, students viewed an online presentation on FRIDs and then participated in instructor guided, in-class application of the MFRAT using student-collected data from an actual patient case. Students completed medication therapy management (MTM) documentation. The assessment data for students who had previously used the MFRAT (experienced) were analyzed separately from first time users (inexperienced). Results. Three assessment scores were evaluated: number correct (maximum 30; higher score is better), number of distractors (maximum 20; lower score better), and a combined total score (maximum 50; higher score better). In inexperienced users (n=104), pre- and post-assessment means improved significantly for correct score (24.9 vs 29.5) and total score (39.4 vs 44.3). Among experienced users (n=10), pre- and post-assessment means improved significantly for correct responses (27.3 vs 29.7), distractors (7.0 vs 3.5), and total score (40.3 vs 46.2). Conclusion. The ability of both pharmacy students who had used the MFRAT previously and those who had not to correctly identify FRIDs increased on the post-assessment.
Language: en

accidental falls; flipped-classroom; medication therapy management; pharmacy students; risk assessment clinical decision support tool


Opioid use and the risk of falls, fall injuries and fractures among older adults: a systematic review and meta-analysis
Yoshikawa A, Ramirez G, Smith ML, Foster M, Nabil AK, Jani SN, Ory MG. J. Gerontol. A Biol. Sci. Med. Sci. 2020; ePub(ePub): ePub.
Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA.
(Copyright © 2020, Gerontological Society of America)
DOI 10.1093/gerona/glaa038 PMID 32016284
BACKGROUND: There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults.
METHODS: A systematic literature search was conducted using nine databases (Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and We log-transformed effect sizes (RR, OR, and HR) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality.
RESULTS: Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity.
CONCLUSION: While heterogeneity is present, results suggest an increased risk of falls, fall injuries, and fractures among older adults who used opioids.
FINDINGS highlight the need for opioid education and non-opioid related pain management interventions among older adults to decrease fall-related risk.
Language: en

Hip Fracture; Medication; Pain


Use of fall risk-increasing drugs around a fall-related injury in older adults: a systematic review
Hart LA, Phelan EA, Yi JY, Marcum ZA, Gray SL. J. Am. Geriatr. Soc. 2020; ePub(ePub): ePub.
Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington.
(Copyright © 2020, John Wiley and Sons)
DOI 10.1111/jgs.16369 PMID 32064594
OBJECTIVES: To examine: (1) prevalence of fall risk-increasing drug (FRID) use among older adults with a fall-related injury, (2) which FRIDs were most frequently prescribed, (3) whether FRID use was reduced following the fall-related healthcare episode, and (4) which interventions have reduced falls or FRID use in older adults with a history of falls.
DESIGN: Systematic review. PARTICIPANTS: Observational and intervention studies that assessed (or intervened on) FRID use in participants aged 60 years or older who had experienced a fall. MEASUREMENTS: PubMed and EMBASE were searched through June 30, 2019. Two reviewers independently extracted data and evaluated studies for bias. Discrepancies were resolved by consensus.
RESULTS: Fourteen of 638 articles met selection criteria: 10 observational studies and 4 intervention studies. FRID use prevalence at time of fall-related injury ranged from 65% to 93%. Antidepressants and sedatives-hypnotics were the most commonly prescribed FRIDs. Of the 10 observational studies, only 2 used a design adequate to capture changes in FRID use after a fall-related injury, neither finding a reduction in FRID use. Three randomized controlled studies conducted in various settings (hospital, emergency department, and community pharmacy) with 12-month follow-up did not find a reduction in falls with interventions to reduce FRID use, although the study conducted in the community pharmacy setting was effective in reducing FRID use. In a nonrandomized (pre-post) intervention study conducted in an outpatient geriatrics clinic, falls were reduced in the intervention group.
CONCLUSIONS: Limited evidence indicates high prevalence of FRID use among older adults who have experienced a fall-related injury and no reduction in overall FRID use following the fall-related healthcare encounter. There is a need for well-designed interventions to reduce FRID use and falls in older adults with a history of falls. Reducing FRID use as a stand-alone intervention may not be effective in reducing recurrent falls.
Language: en

fall-related injury; medications; older adults; systematic review


The impact of pharmacy-directed medication management for patients experiencing falls in a veterans affairs community living center
McBride K, Tomlin B. Sr. Care Pharm. 2020; 35(3): 126-135.
(Copyright © 2020, American Society of Consultant Pharmacists)
DOI 10.4140/TCP.n.2020.126 PMID 32070461
OBJECTIVE: To analyze medication interventions prior to and following implementation of the Pharmacy Medication Related Falls Risk Assessment consult service in an older adult population. DESIGN: Retrospective chart review. SETTING: This study involved patients admitted to the Cincinnati Veterans Affairs Medical Center’s (VAMC) Community Living Center (CLC), an institutional practice setting. PATIENTS, PARTICIPANTS: Any patient who experienced a fall while admitted to the CLC during fiscal years 2013 or 2018 was considered for inclusion. Patients were excluded if falls were not evaluated by a provider, the patient expired within 10 days after falling, or falls in fiscal year 2018 that did not have a pharmacy consult placed. Fifty falls from each fiscal year were selected. MAIN OUTCOME MEASURES: The primary endpoint encompassed the number of pharmacy medication interventions made within 10 days postfall, with a secondary endpoint evaluating subsequent falls within 30 days of initial event. RESULTS: Following consult implementation, a larger number of pharmacist recommendations (40 vs. 123) and subsequent interventions (accepted recommendations) within ten days postfall (12 vs. 49) were completed. There were 14 subsequent falls within 30 days of the initial event for both fiscal years. A larger percentage of falls and patients experiencing falls from each fiscal year did not receive previous medication interventions. CONCLUSION: Consult implementation increased the number of pharmacist recommendations and subsequent interventions for patients within ten days postfall, reducing the risk of adverse effects, drug-drug interactions, subsequent falls, and polypharmacy.
Language: en