Reducing psychotropic drugs reduces falls in elderly people

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7309.402 (Published 18 August 2001) Cite this as: BMJ 2001;323:402
  1. J W Cooper, professor of clinical and administrative sciences (jcooper{at}rx.uga.edu)
  1. College of Pharmacy, University of Georgia, Athens, GA 30602-2354, USA

    EDITOR—Swift discusses implementing effective services for elderly people who fall. He mentions polypharmacy as a factor contributing to falls but not that reducing polypharmacy is an effective service that should be implemented.1

    Admissions to hospital for injuries related to falling are second only to gastropathy from non-steroidal anti-inflammatory drugs as the leading cause of acute admissions among residents of nursing facilities.2 An increasing body of evidence, ranging from non-randomised open label trials to randomised controlled trials, shows that reducing psychotropic drugs may reduce falls by 30-75%, but this intervention was not advocated by Swift.3-5

    Horner and I recently reported the results of a 19 month investigation among frail elderly residents of a nursing facility (JW Cooper, MR Horner, mid-year clinical meeting, American Society of Health System Pharmacists, Las Vegas, December 2000). We found that the risk of falling was directly related to the number of psychotropic agents administered regularly. We also found that the risk of admission to hospital from all causes was doubled in frail elderly people with and without a diagnosis of dementia who used psychotropic agents compared with all residents who did not use psychotropic drugs.

    Lightening the load of psychotropic drugs should be considered a viable and effective way of reducing the risk of falls and their consequences in the care of older people.


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