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Home Care Fall Risk Intervention and Psychotropic Drugs
- James W Cooper (21 October 2000)
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Home Visit and Falls in Elderly People
- Luiz Garcez-Leme (21 October 2000)
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An intervention trial on falls and impairments in elderly people?
- Hubert A A M Maas (16 November 2000)
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James W Cooper, Professor of Clinical and Adminsistrative Sciences College of Pharmacy, University of Georgia
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The recent study of multifactorial home visits effect on falls (1) did not mention the drug history of those elderly who received the program. There was also no mention of whether there was any intevention attempted with psychotropic drugs that are associated with falls (2). Interventional studies in long-term care elderly have found that psychotropic drugs contribute to 85% of falls and that dose reduction, psychotropic removal and conversion to buspirone may reduce falls by up to 75% over a one-year period (3,4,5).More recently the rate of falls and fall-related hospitalizations has been directly correlated with the number of psychotropic drugs used (6). A recent study of psychotropic medication withdrawal and a home-based exercise program also reduced the risk of falls by two-thirds over a 44 week period (7). It would help to better understand why an 18-month multifactorial interventional program (1) had no effect on falls if there was a record of medication usage over that period that could be shared with colleagues. References 1. van Haastregt JCM, et al. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomized controlled trial. Br Med J 2000;321:994-998 2. Leipzig RM, et al. Drugs and falls in older people: a systematic review and meta-analysis: I. psychotropic drugs. JAGS 1999;47:30-39. 3.Cooper JW. Consultant pharmacist assessment and reduction of fall risk in nursing facilities. Consult Pharm 1997; 12: 1294-1304. 4.Cooper JW. Consultant pharmacist assessment of fall injury incidence and costs within a nursing facility. Consult Pharm 1997; 12: 1305-1309. 5.Cooper JW. Reducing falls among patients in nursing homes. JAMA 1997;278: 1742. 6.Horner MR, Cooper JW .Psychotropic and psychoactive drug load assessment, fall risk and hospitalizations in nursing facility residents, Amer Soc of Health Systems Pharm Mid-year Clinical Meeting, Las Vegas, December 2000, abstract P-511E 7.Campbell AJ, et al. Psychotropic medication withdrawal and a home-based exercsie program to prevent falls: a randomized, controlled trial. JAGS 1999;47:850-853. |
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Luiz Garcez-Leme, Assistant Professor Faculdade de Medicina da Universidade de São Paulo (Brasil)
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Very interesting the paper of van Haastregt and co-workers1 about Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial. In our serviçe of Orthogeriatrics in the University of São Paulo School of Medicine (Hospital das Clínicas da Faculdade de Medicina da Universidade de São paulo) in Brazil, we could have the experience of a program of interprofessional home visit after 7 to 10 days of the discharge of elderly patients hospitalized for orthopedic procedures, mainly hip fracture surgery. Our experience, not yet published, is that this kind of support could be very important to the patients and the families, both in giving orientation to patient and careers to improve behavior and ambient security and, giving an important support to prevent or reduce the fear for falling, a very common complication in families and patients that experienced a fall. Our first result tend to give us the impression of have a consistent reduction of new falls, as reported previously by Gillespie and co-workers2 So, our experience, of course limited to an developing country, is that the cost related benefit of home visit to elderly patients that experienced a fall with complication (fracture) could be very good both in level of public health and in heath professionals education 1. Effects of a programmed of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomized controlled trial Jolanda C M van Haastregt, Jos P M Diederiks, Erik van Rossum, Luc P de Witte, Peter M Voorhoeve, and Harry F J M Crebolder BMJ 2000; 321: 994-998 2. Gillespie LD, Gillespie WJ, Cumming R, Lamb SE, Rowe BH. Interventions to reduce the incidence of falling in the elderly. Cochrane Library 1997; 4: 1-29 |
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Hubert A A M Maas, consultant geriatrician TweeSteden hospital tilburg the Netherlands
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Van Haastregt et al conclude that multifactorial home visits have no effects on falls and impairments in mobility in elderly people(1). However, the trial consisted of screening tools and no exact information was given about the interventions that followed the screening phase. In my opinion the interventions should be categorised and, if possible, be judged by their effects and compliance. In an earlier review(2) to assess the effect of preventive home visits most of the authors argued that trials should provide information about the characteristics of the interventions, about the extent to which interventions were proposed and their compliance. To my surprise almost no information is given on these issues. This lack of information strongly limits the conclusion and the comparison with other reports on this topic. Hubert AAM Maas 1 Van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Voorhoeve PM, Crebolder HFJM. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial. BMJ 2000;321:994-8 2 Van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Crebolder HFJM. Effects of preventive home visits to elderly people living in the community: systematic review. BMJ 2000;320:754-8 |
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