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Medication Use and Fall-Related Hospital Admissions from Long-Term Care Facilities: A Hospital-Based Case–Control Study

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Abstract

Background

Falls are a leading cause of preventable hospitalizations from long-term care facilities (LTCFs). Polypharmacy and falls-risk medications are potentially modifiable risk factors for falling.

Objective

This study investigated whether polypharmacy and falls-risk medications are associated with fall-related hospital admissions from LTCFs compared with hospital admissions for other causes.

Methods

This was a hospital-based, case–control study of patients aged ≥65 years hospitalized from LTCFs. Cases were patients with falls and fall-related injuries, and controls were patients admitted for infections. Conditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between polypharmacy (defined as the use of nine or more regular pre-admission medications) and falls-risk medications (categorized as psychotropic medications and those that can cause orthostatic hypotension) with fall-related hospital admissions.

Results

There was no association between polypharmacy and fall-related hospital admissions (adjusted OR 0.97, 95% CI 0.63–1.48); however, the adjusted odds of fall-related hospital admissions increased by 16% (95% CI 3–30%) for each additional falls-risk medication. Medications that can cause orthostatic hypotension (adjusted OR 1.25, 95% CI 1.06–1.46), but not psychotropic falls-risk medications (adjusted OR 1.02, 95% CI 0.88–1.18) were associated with fall-related hospital admissions. The association between medications that can cause orthostatic hypotension and fall-related hospital admissions was strongest among residents with polypharmacy (adjusted OR 1.44, 95% CI 1.08–1.92).

Conclusion

Polypharmacy was not an independent risk factor for fall-related hospital admissions; however, medications that can cause orthostatic hypotension were associated with fall-related hospital admissions, particularly among residents with polypharmacy. Falls-risk should be considered when prescribing medications that can cause orthostatic hypotension.

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Acknowledgements

The authors would like to thank Jessica Bailey and Grace Wan for their assistance with data management.

Author information

Author notes

  1. Taliesin E. Ryan-Atwood and Mieke Hutchinson-Kern contributed equally to this work.

Authors and Affiliations

  1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia

    Taliesin E. Ryan-Atwood, Mieke Hutchinson-Kern, Jenni Ilomäki, Michael J. Dooley, Susan G. Poole, Carl M. Kirkpatrick & J. Simon Bell

  2. Department of Epidemiology and Preventive Medicine, Faculty of Nursing, Medicine and Health Sciences, Monash University, Melbourne, VIC, Australia

    Jenni Ilomäki, Biswadev Mitra & J. Simon Bell

  3. Pharmacy Department, Alfred Health, Melbourne, VIC, Australia

    Michael J. Dooley & Susan G. Poole

  4. School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia

    Elizabeth Manias

  5. Departments of Nursing and Medicine, The University of Melbourne, Melbourne, VIC, Australia

    Elizabeth Manias

  6. Emergency Department, Alfred Health, Melbourne, VIC, Australia

    Biswadev Mitra

  7. Sansom Institute, University of South Australia, Adelaide, VIC, Australia

    J. Simon Bell

Authors
  1. Taliesin E. Ryan-Atwood
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Corresponding author

Correspondence to J. Simon Bell.

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Funding

The authors gratefully acknowledge the Ageing and Aged Care Branch, Department of Health and Human Services, State Government of Victoria, for commissioning and funding this research. Jenni Ilomäki was supported by a National Health and Medical Council Early Career Fellowship.

Conflicts of interest

Taliesin Ryan-Atwood, Mieke Hutchinson-Kern, Jenni Ilomäki, Michael Dooley, Susan Poole, Carl Kirkpatrick, Elizabeth Manias, Biswadev Mitra and Simon Bell declare that they have no conflicts of interest relevant to the content of this study.

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Ryan-Atwood, T.E., Hutchinson-Kern, M., Ilomäki, J. et al. Medication Use and Fall-Related Hospital Admissions from Long-Term Care Facilities: A Hospital-Based Case–Control Study. Drugs Aging 34, 625–633 (2017). https://doi.org/10.1007/s40266-017-0472-8

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  • DOI: https://doi.org/10.1007/s40266-017-0472-8

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