Fall-related hospital admissions in elderly patients: Contribution of medication use

Abstract

Aim: To determine the incidence of falls in elderly patients and possible association with medication use. Method: Using the International Classification of Diseases (ICD-10, AM) codes for falls, the medical records of patients over 60 years of age discharged from Toowoomba Base Hospital during the period 1 January to 31 May 2000 were retro-spectively reviewed. Medications on admission were assessed to ascertain their possible contribution to the fall. Falls were assigned ratings (strong, moderate, weak, or no association) following review by a panel of pharmacists and consideration of confounding factors. Results: One hundred and fifteen patients fulfilled the criteria. Thirteen patients fell whilst in hospital. Medications considered most likely to have contributed were cardiovascular (52%), psychotropic (40%), and analgesic (8%) agents. Excessive alcohol consumption contributed to seven falls (6%). Four incidents (3%) were assigned a strong association. Of these, two were attributed to orthostatic hypotension, one to a combination of orthostatic hypotension and central nervous system (CNS) effects, and the other was due to ataxia caused by phenytoin toxicity confounded by possible haloperidol-induced parkinsonian symptoms. Drug therapy was moderately associated with 11 falls (10%), weakly associated with 72 falls (63%) and there was no drug involvement in 21 falls (18%). Conclusion: Falls are associated with significant morbidity and mortality and are a huge burden on the healthcare budget. Medication use can be an important factor in increasing the risk of falls in the elderly. Pharmacists, both hospital and community, are in an ideal position to review patients' medication and make necessary interventions to help reduce the risk of this serious and expensive problem.