Falls and psychotropic drug consumption in long-term care residents: is there an obvious association?

Institutional long-term care is an integrated part of primary health care. People qualifying to enter a long-term care facility must exhibit a high degree of dependency, caused either by physical or/and mental impairment. It must be obvious that the problem cannot be dealt with in the community. The type of the residents in institutions largely depends on the ability to provide proper services to elderly living in the community. This also implies that fall-related risk factors may vary. Residents living permanently in a long-term care facility (n = 118) were observed during a 6-month period with respect to fall episodes. Prior to the study, gender age, mental capacity, mobility, the ability to go to the toilet, to eat, and to communicate, and all drugs prescribed on a regular schedule were recorded. Subsequently the various elements were compared for fallers and non-fallers. There were 49 fallers. There was no difference between the two groups regarding gender, age, or drug use. Mental impairment and restricted mobility were independently associated with increased risk of falling (odds ratios 3.4 and 4.8, respectively). Falling was also associated with the degree of mental impairment (linear trend p = 0.01). A stratified Mantel-Haenszel test showed a significantly higher tendency to fall among residents using antipsychotics. Residents with restricted mobility using anxiolytics/hypnotics or antidepressants had a lower tendency to fall than non-users. They were also less prone to fall repeatedly. Anxiety and depressive states may possibly contribute to falling. Negative associations between falling and drug use are commonly studied. Possible beneficial effects are by and large disregarded.