Psychotropic medications and falls in nursing homes: Could frailty be a gamechanger?

Introduction: Nursing home (NH) residents include individuals with a high risk of frailty and who are also particularly vulnerable to adverse effects of medications including falls. The aim of the study was to evaluate the role of frailty as potential effect modifier in the relationship between psychotropic medications and falls among NH residents. Method(s): Retrospective cohort study conducted on 4,096 NH residents in 7 European countries and Israel from the Services and Health for Elderly in Long TERm care (SHELTER) project. Participants were assessed through the interRAI long-term care facility instrument. Frailty was defined according to the FRAIL-NH scale. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) adjusted for potential confounders were estimated from logistic regression models before and after stratification on frailty status to evaluate the association between psychotropic medications and falls. Result(s): Overall 774 residents had history of fall in the 12 months before the assessment. Falls were associated with frailty, ADL impairment, worse cognitive status, cancer, stroke, polypharmacy, use of antidepressants, antipsychotics, and antidementia drugs (p<0.05 for all), but not with benzodiazepines. After stratifying on frailty, the risk of falls was increased for residents on antipsychotics (adj. OR 1.53, 95%CI 1.15-2.03), on antidepressants (adj. OR 1.41, 95%CI 1.07-1.85), on antidementia drugs (adj. OR 1.98, 95%CI 1.32-2.95). Psychotropic medications were not associated with falls in robust residents. Key conclusions: Frailty may modify the effect of psychotropic medications contributing to the observed increased risk of falls in NH residents. Frailty should always assessed especially among residents with polypharmacy.

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