Batool Narjis, Raban Magdalena Z, Seaman Karla, Westbrook Johanna, Wabe Nasir
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
BMJ Open. 2025 Apr 9;15(4):e096187. doi: 10.1136/bmjopen-2024-096187.
Falling is common among older adults in residential aged care facilities (RACFs) and potential inappropriate psychotropic medicines (PIPMs) use may increase the risk of falling. This study aimed to determine the impact of PIPMs on falls using longitudinal observational data.
A retrospective longitudinal cohort study was conducted using routinely collected electronic health data from 23 RACFs in Sydney, New South Wales, Australia. The study included 3064 permanent residents aged ≥65 (2020-2021). PIPMs were identified using updated Beers criteria 2023. We considered three fall outcome groups: all falls, injurious falls and falls requiring hospitalisation. The falls incidence rates (IRs) were calculated for overall residents in RACFs as well as for central nervous system (CNS)-PIPM users and non-users. We applied a zero-inflated negative binomial regression model to assess the association between falls and CNS-PIPMs.
A total of 40% (n=1224) of long-term care residents used at least one CNS-PIPM and 10% of residents (n=302) used two or more. The falls IRs of CNS-PIPM users were 16.2 falls per 1000 resident days (95% CI 15.9 to 16.5) for all falls, 5.68 falls per 1000 resident days (95% CI 5.48 to 5.88) for injurious falls and 1.77 falls per 1000 resident days (95% CI 1.66 to 1.88) for falls requiring hospitalisation, whereas the falls IRs of non-CNS-PIPM users were 10.8 falls per 1000 resident days (95% CI 10.6 to 11.0) for all falls, 3.65 falls per 1000 resident days (95% CI 3.52 to 3.78) for injurious falls and 1.26 falls per 1000 resident days (95% CI 1.19 to 1.33) for falls requiring hospitalisation. CNS-PIPM users had a significantly greater rate of falls overall compared with non-users (IRR 1.29; 95% CI 1.16 to 1.44) for all outcomes.
Falls are frequent among CNS-PIPM users resulting in injury and hospitalisation, with 70% of CNS-PIPM users falling at least once and one in three requiring admissions to hospital. Reviewing residents' use of psychotropic medicines should be considered as part of strategies to reduce falls incidence among older adults in RACFs.
在老年护理机构（RACFs）中，跌倒在老年人中很常见，潜在的不适当精神药物（PIPMs）使用可能会增加跌倒风险。本研究旨在利用纵向观察数据确定PIPMs对跌倒的影响。
采用回顾性纵向队列研究，使用从澳大利亚新南威尔士州悉尼的23个RACFs常规收集的电子健康数据。该研究纳入了3064名年龄≥65岁的常住居民（2020 - 2021年）。使用2023年更新的Beers标准识别PIPMs。我们考虑了三个跌倒结果组：所有跌倒、伤害性跌倒和需要住院治疗的跌倒。计算了RACFs中全体居民以及中枢神经系统（CNS） - PIPM使用者和非使用者的跌倒发生率（IRs）。我们应用零膨胀负二项回归模型来评估跌倒与CNS - PIPMs之间的关联。
共有40%（n = 1224）的长期护理居民使用至少一种CNS - PIPM，10%的居民（n = 302）使用两种或更多种。CNS - PIPM使用者的跌倒发生率为：所有跌倒每1000居民日16.2次跌倒（95%CI 15.9至16.5），伤害性跌倒每1000居民日5.68次跌倒（95%CI 5.48至5.88），需要住院治疗的跌倒每1000居民日1.77次跌倒（95%CI 1.66至1.88）；而CNS - PIPM非使用者的跌倒发生率为：所有跌倒每1000居民日10.8次跌倒（95%CI 10.6至11.0），伤害性跌倒每1000居民日3.65次跌倒（95%CI 3.52至3.78），需要住院治疗的跌倒每1000居民日1.26次跌倒（95%CI 1.19至1.33）。总体而言，CNS - PIPM使用者的跌倒发生率显著高于非使用者（所有结果的IRR 1.29；95%CI 1.16至1.44）。
CNS - PIPM使用者中跌倒频繁，导致受伤和住院，70%的CNS - PIPM使用者至少跌倒一次，三分之一需要住院治疗。审查居民精神药物的使用应被视为降低RACFs中老年人跌倒发生率策略的一部分。
