The Evaluation of Falls in the Emergency Department

Medication use and risk of falls

PURPOSE

Injuries due to falls are an important public health concern, particularly for the elderly, and effective prevention is an ongoing endeavour. The present study has two related objectives: (1) to describe associations between drug use and falls in an institutionalized population, and (2) to identify a high risk subgroup within the larger population.

METHODS

The initial analysis was based on a population of 227 residents who were followed over a 1-year period. Logistic regression techniques were used to estimate odds ratios (ORs) of the association of falls and drug use. The study of potential 'high-risk' groups employed a case-crossover design to estimate the risk of falling associated with starting a new drug course.

RESULTS

Relatively weak ORs for risk of falling were observed for various drug classes; the highest OR was for benzodiazepines (BZD) at OR = 1.8 (unadjusted). Residents taking multiple drugs were at particular risk for falling, e.g. an OR of 6.1 for those using 10+ drugs. The case-crossover analysis indicated that residents starting a new BZD/antipsychotic were at very high risk (OR = 11.4) for experiencing a fall.

CONCLUSIONS

Residents who took many different types of medications, as well as residents starting a new BZD/antipsychotics were at greatly increased risk of falling. These are high risk groups where increased monitoring or adjustments to drug regimens could lead to prevention of falls.

Benzodiazepine use among elderly patients presenting at the emergency room

This study evaluated the prevalence of benzodiazepine intake by elderly patients presenting at the emergency room of a university hospital. Of 388 patients, 42.5% used one or more benzodiazepine (BZD) drugs in the week prior to admission. There were significantly more women among the BZD users (P < 0.05). Mean duration of intake was long (62 months), but daily dosage was adjusted to age. Of the BZD using patients, 27% took a BZD with long elimination half life. No relationship was found between the BZD intake and the occurrence of falls. Fallers were significantly older (P = 0.019) and were more often women (P = 0.046).