Opportunities for quality improvement in long term care (LTC): Medication related contributors to falls among older residents of a retirement community

Background & rationale: Falls are common in older people. They are potentially preventable and are associated with significant morbidity and mortality. Medications represent modifiable risk factors and opportunity to lower fall risk.

Purpose: To identify medications that may have contributed to falls among older people who recently fell and investigate facility care processes to identify methods to increase awareness of medications as falls risk factors.

Methods: Incident falls were identified from a registry. Medical and sociodemographic information was collected from medical charts. Male and female residents of two LTC facilities who fell between July 31st, 2009-july 31st, 2010, were 65 years of age or older and whose ambulatory status was independent, with cane, or with walker were assessed by the principal investigator.

Results: To date, data have been collected for 43 residents. 58% suffered one fall, 24% two falls, 9% three falls and 9% > 4 falls. Residents received an average of 8.5 medications. Antihypertensives, antidepressants, antipsychotics, hypnotic/sedatives, and antiepileptic drugs were used by 68%,57%, 38%, 27%, and 19%. Among those who experienced >1 fall, the 5 most common medications taken were antidepressants (66%), antihypertensives (61%), acetaminophen (55%), furosemide (44%), and sedative hypnotics (44%). Of the medications that residents were taking which are known to be associated with falls, 55% could have been modified in order to decrease patientŐs fall risk. Only 44% & 38% of residents were taking vitamin D or calcium supplements. Awareness of medications as modifiable risk factors by health providers appears inadequate, and care processess do not appear to be aligned for optimal fall risk reduction with regards to medications.

Conclusions: Medication contributors to falls are commonplace in this population. Various opportunities exist to improve care processes to decrease fall risk. Work is ongoing to develop sustainable methods to heighten awareness of medicationŐs role in falls.