Medication-Related Fall Incidents in an Older, Ambulant Population: The B-PROOF Study Predisposing and precipitating factors for falls among older people in residential care. Risk factors for falls in a community-based prospective study of people 70 years and older. Inappropriate medication use and risk of falls – A prospective study in a large community-dwelling elderly cohort Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE). An Electronic Medical Record (EMR)-Based Intervention to Reduce Polypharmacy and Falls in an Ambulatory Rural Elderly Population Falls-Related Drug Use and Risk of Falls Among Older Adults: A Study in a US Medicare Population Impact of enhanced pharmacologic care on the prevention of falls: a randomized controlled trial. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. Factors associated with falling in elderly hospital patients. Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults. Guidelines for the prevention of falls in people over 65 Falls as a complication of diabetes mellitus in older people. Falls and Fall-Related Injuries Associated With Function-Focused Care Medications and multiple falls in elderly people: the St Louis OASIS study. Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study ‘Good Ageing in Skåne’ Risk indicators for falls in institutionalized frail elderly.
Background Medication use is a potentially modifiable risk factor for falling ;  psychotropic and cardiovascular drugs have been indicated as main drug groups that increase fall risk . However , evidence is mainly based on studies that recorded falls retrospectively and /or did not determine medication use at the time of the fall . Therefore , we investigated the associations indicated in the literature between medication use and falls , using prospect ively recorded falls and medication use determined at the time of the fall . Methods Data from the B-PROOF ( B-vitamins for the prevention of osteoporotic fractures ) study were used , concerning community-dwelling elderly aged ≥65 years . We included 2,407 participants with pharmacy dispensing records . During the 2- to 3-year follow-up , participants recorded falls using a fall calendar . Cox proportional hazard models were applied , adjusting for potential confounders including age , sex , health status variables and concomitant medication use . Results During follow-up , 1,147 participants experienced at least one fall . Users of anti-arrhythmic medication had an increased fall risk ( hazard ratio [ HR ] 1.61 ; 95 % confidence interval [ CI ] 1.12–2.32 ) compared with non-users . Similarly , non-selective beta-blocker use was associated with an increased fall risk ( HR 1.41 [ 95 % CI 1.12–1.78 ] ) , while statin use was associated with a lower risk ( HR 0.81 [ 95 % CI 0.71–0.94 ] ) . Benzodiazepine use ( HR 1.32 [ 95 % CI 1.02–1.71 ] ) , and antidepressant use ( HR 1.40 [ 95 % CI 1.07–1.82 ] ) were associated with an increased fall risk . Use of other cardiovascular and psychotropic medication was not associated with fall risk . Conclusion Our results strengthen the evidence for an increased fall risk in community-dwelling elderly during the use of anti-arrhythmics , non-selective beta-blockers , benzodiazepines , and antidepressant medication . Clinicians should prescribe these drugs cautiously and if possible choose safer alternatives for older patients Falls and their consequences are serious health problems among older population s. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospect i ve follow up for falls . Fifty-eight women and 25 men , with a mean age of 79.6 y , were included and prospect ively followed up regarding falls for a period of 1 y after baseline assessment s. All those who fell were assessed regarding factors that might have precipitated the fall . The incidence rate was 2.29 falls/person years . Antidepressants ( selective serotonin reuptake inhibitors , SSRIs ) , impaired vision and being unable to use stairs without assistance were independently associated with being a ' faller ' . Twenty-eight ( 53.8 % ) of the fallers suffered injuries as a result of their falls , including 21 fractures . Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6 % by a side effect of a drug . Acute symptoms of diseases or drug side effects were associated with 58 % of the falls which result ed in fractures . We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall , once or repeatedly . Since acute illnesses and drug side-effects were important precipitating factors , falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise We investigated factors associated with falls in a community-based prospect i ve study of 761 subjects 70 years and older . The group experienced 507 falls during the year of monitoring . On entry to the study a number of variables had been assessed in each subject . Variables associated with an increased risk of falling differed in men and women . In men , decreased levels of physical activity , stroke , arthritis of the knees , impairment of gait , and increased body sway were associated with an increased risk of falls . In women , the total number of drugs , psychotropic drugs and drugs liable to cause postural hypotension , st and ing systolic blood pressure of less than 110 mmHg , and evidence of muscle weakness were also associated with an increased risk of falling . Most falls in elderly people are associated with multiple risk factors , many of which are potentially remediable . The possible implication s of this in diagnosis and prevention are discussed Background Explicit criteria for determining potentially inappropriate medication consumption in elderly were elaborated by Beers et al. These lists have been used worldwide to evaluate medical prescriptions but there is little epidemiologic evidence demonstrating negative consequences of inappropriate medication use . It has been reported that some drugs could increase the risk of falls , which are a frequent and serious problem in elderly population . We aim ed to evaluate the association between the use of potentially inappropriate medications and the risk of falls . Methods The 3C Study is a multicentre prospect i ve cohort study conducted in France with 4 years of follow-up . Non-institutionalized men and women aged 65 years or over ( N = 6343 ) were r and omly selected from electoral rolls . Data on socio-demographic , medical characteristics and medication use ( based on self-reports and data from the national healthcare insurance ) were collected . Use of inappropriate medication for elderly was defined from established criteria . Data about falls were collected at the two follow-up examinations ( 2 years and 4 years after baseline ) . The association between the exposure to inappropriate medications and the risk of falls was evaluated using multivariate models ( Cox model and logistic regression ) . Results 32 % of subjects reported inappropriate medication use at baseline and 29 % at least two of the three examinations ; 22 % had fallen 2 times or more during follow-up . Overall , inappropriate medication users had an increased risk of falling . This increase was mainly due to the use of long-acting benzodiazepines ( adjusted odds ratio ( OR ) = 1.4 , 95 % confidence interval : [ 1.1–1.8 ] , in both occasional and regular users ) , other inappropriate psychotropics ( adjusted OR = 1.7 [ 1.7–2.7 ] in regular users ) , or medication with anticholinergic properties ( adjusted OR = 1.6 [ 1.2–2.1 ] in regular users ) . Neither occasional , nor regular use of short- or intermediate-acting benzodiazepines was associated with an increased risk of falling . Further analysis in long-acting benzodiazepines users did not show any dose-effect relation between the number of prescriptions filled over a 3-year period and the risk of falling . Conclusion Our study showed that use of inappropriate medications was associated with an increased risk of falling in elderly persons . This increase was mainly due to long-acting benzodiazepines and other inappropriate psychotropics , and to medications with anticholinergic properties The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric in patients and develop a screening tool to accurately predict falls . The study sample consisted of 225 geriatric-psychiatric in patients at a Midwestern referral facility . The sample included 136 in patients who fell and a r and om stratified sample of 89 in patients who did not fall . Data collected included age , gender , activities of daily living , and nursing parameters such as bathing assistance , bed height , use of bed rails , one-on-one observation , fall warning system , Conley Scale fall risk assessment , medical diagnosis , and medications . History of falls , impaired judgment , impaired gait , dizziness , delusions , delirium , chronic use of sedative or antipsychotic agents , and anticholinergic urinary bladder medications significantly increased fall risk . Alzheimer 's disease , acute use of sedative or anti-psychotic agents , and depression reduced fall risk . A falls risk tool , Fall Risk Assessment in Geriatric-psychiatric In patients to Lower Events ( FRAGILE ) , was developed for assessment and risk stratification with new diagnoses or medications Background Falls are the leading cause of injury-related deaths in the aging population .  Electronic medical record ( EMR ) systems can identify at-risk patients and enable interventions to decrease risk factors for falls . Objective The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use , psychoactive medication use , and occurrence of falls in an ambulatory elderly population at risk for falls . Design Prospect i ve , r and omized by clinic site . Patients / Participants Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use . Interventions A st and ardized medication review was conducted and recommendations made to the primary physician via the EMR . Measurements and Main Results Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study . Fall-related diagnoses and medication data were collected through the EMR . A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups , adjusting for baseline medication patterns and comorbidities . Although the intervention did not reduce the total number of medications , there was a significant negative relationship between the intervention and the total number of medications started during the intervention period ( p < .01 , regression estimate −0.199 ) and the total number of psychoactive medications ( p < .05 , regression estimate −0.204 . ) The impact on falls was mixed ; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis ( p < .01 ) ; when data on self-reported falls was included , a nonsignificant reduction in fall risk was seen . Conclusions The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population Background Approximately one-third of community-dwelling older adults fall each year , and approximately 10 % have falls requiring medical services . Among other factors , research studies have linked certain medications with an increased risk of falls . Objective The aim of this study was to examine the risk of falls relative to use patterns among new and continuing falls-related drug ( FRD ) users . Methods A 10 % r and om sample , insured in AARP ® Medicare Supplement and AARP Medicare Part D Rx plans , was utilized to define new and continuing FRD users . New users had a 12-month pre-period without FRD use , whereas continuing users had at least one FRD in the pre-period . Both groups had 12-month follow-up after initiating or continuing FRD use . Characteristics associated with the risk of falls for new and continuing users were determined using multivariate logistic regression models . Results Among insureds , 44 % used at least one of the FRD classes . Of these , 29 % were new users ( N = 35,340 ) and 71 % were continuing users ( N = 121,488 ) . Fall rates for the two subgroups were similar at 7 and 8 % , respectively . Characteristics associated with the risk of falls were previous injurious fall , use of two or more classes of FRDs , older age , poorer health , and being female . New users were at higher risk than continuing users . Conclusion New users of FRDs  were at highest risk of falls , and continuing users were at increased risk , especially with higher numbers of FRD classes . Both groups could benefit from falls awareness and prevention programs BACKGROUND Falls are the leading cause of both fatal and nonfatal injuries among older adults in the United States . Medications that affect the central nervous system are known to increase the risk of falling . OBJECTIVE The purpose of this study was to assess the effects of a community pharmacy-based falls-prevention program targeting high-risk older adults on the rates of recurrent falls , injurious falls , and filling prescriptions for medications that have been associated with an increased risk of falling . METHODS This was a r and omized controlled trial of participants recruited through a community pharmacy chain in North Carolina . The 2-year study consisted of a 1-year " look-back " period before r and omization and a 1-year follow-up period after r and omization . Patients were eligible to participate if they were ≥65 years of age , had fallen at least once during the 1-year period preceding enrollment , and were taking medications associated with an increased risk of falling . Medications classified as high risk included benzodiazepines , antidepressants , anticonvulsants , sedative hypnotics , opioid analgesics , antipsychotics , and skeletal muscle relaxants . Participants were assigned to either the intervention arm or the control arm ; participants in the intervention arm were invited to attend a face-to-face medication consultation conducted by a community pharmacy resident , whereas those in the control arm received no medication consultation . The primary end point was the rate of recurrent falls during the 1-year followup period . Secondary end points were the total number of prescriptions for high-risk medications filled during the follow-up period and either discontinued use or a reduction in the dosage of a high-risk medication during the follow-up period . RESULTS One hundred eighty-six patients ( 132 women , 54 men ; 88.7 % white ) were enrolled . Intention-to-treat ( ITT ) analyses revealed no significant differences in the rates of recurrent falls , injurious falls , or filling prescriptions for high-risk medications . However , 13 patients in the intervention group either discontinued use of a high-risk medication or had the dosage reduced during the follow-up period , compared with 5 patients in the control group ( χ(2 ) = 3.94 ; P < 0.05 ) . As-treated analyses revealed numeric reductions in the rates of falls ( rate ratio [ RR ] = 0.76 ; 95 % CI , 0.53 - 1.09 ) , injurious falls ( RR= 0.67 ; 95 % CI , 0.43 - 1.05 ) , and filling prescriptions for high-risk medications ( RR= 0.85 ; 95 % CI , 0.72 - 1.03 ) after receipt of the intervention , but the differences were not statistically significant . CONCLUSIONS Results of this study support the feasibility of using community pharmacies to deliver a falls-prevention program targeting high-risk older adults . Although the ITT analyses revealed no significant reduction in the rate of recurrent falls , injurious falls , or overall use of high-risk medications , individuals in the intervention group were more likely than those in the control group to discontinue use of a high-risk medication or have the dosage reduced during the 1-year follow-up period . More work is needed to evaluate the intervention using a larger sample size that provides greater power to detect clinical ly meaningful effects of reduction in the use of high-risk medications on preventing or reducing falls in the high-risk population BACKGROUND Since falling is associated with serious morbidity among elderly people , we investigated whether the risk of falling could be reduced by modifying known risk factors . METHODS We studied 301 men and women living in the community who were at least 70 years of age and who had at least one of the following risk factors for falling : postural hypotension ; use of sedatives ; use of at least four prescription medications ; and impairment in arm or leg strength or range of motion , balance , ability to move safely from bed to chair or to the bathtub or toilet ( transfer skills ) , or gait . These subjects were given either a combination of adjustment in their medications , behavioral instructions , and exercise programs aim ed at modifying their risk factors ( intervention group , 153 subjects ) or usual health care plus social visits ( control group , 148 subjects ) . RESULTS During one year of follow-up , 35 percent of the intervention group fell , as compared with 47 percent of the control group ( P = 0.04 ) . The adjusted incidence-rate ratio for falling in the intervention group as compared with the control group was 0.69 ( 95 percent confidence interval , 0.52 to 0.90 ) . Among the subjects who had a particular risk factor at base line , a smaller percentage of those in the intervention group than of those in the control group still had the risk factor at the time of re assessment , as follows : at least four prescription medications , 63 percent versus 86 percent , P = 0.009 ; balance impairment , 21 percent versus 46 percent , P = 0.001 ; impairment in toilet-transfer skills , 49 percent versus 65 percent , P = 0.05 ; and gait impairment , 45 percent versus 62 percent , P = 0.07 . CONCLUSIONS The multiple-risk-factor intervention strategy result ed in a significant reduction in the risk of falling  among elderly persons in the community . In addition , the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group , as compared with the control group . Thus , risk-factor modification may partially explain the reduction in the risk of falling Forty-four patients aged 65 years and over who fell whilst in an acute hospital and 44 patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with falling . The control subjects were matched for age ( + /- 3 years ) , sex , patient type , and primary diagnosis . The examination was based on established assessment s of posture , balance and gait , the musculoskeletal system , vision , cardiovascular status , and neurological function . Bivariate analyses revealed seven assessment measures that were significantly associated with falls : cognitive impairment , particularly impaired orientation ; evidence of previous cerebrovascular accident ; incoordination as measured clinical ly ; inability to perform the ' Get-up- and -go ' test , especially an inability to turn around after a 5-metre walk , and the use of psycho-active medications . Of these variables , impaired orientation , psycho-active drug use , evidence of stroke , and impaired performance in the ' Get-up- and -go ' test were included in a stepwise logistic regression which correctly classified 80 % of the patients into faller and non-faller groups . Falling was also related to the number of these identified risk factors . These findings suggest that a simple screening protocol , taking about 5 min to complete , can assist in the identification of patients at risk of falls whilst in hospital BACKGROUND polypharmacy is an important risk factor for falls , but recent studies suggest only when including medications associated with increasing the risk of falls . DESIGN a prospect i ve , population -based cohort study . SUBJECTS 6,666 adults aged ≥50 years from The Irish Longitudinal study on Ageing . METHODS participants reported regular medication use at baseline . Any subsequent falls , any injurious falls and the number of falls were reported 2 years later . The association between polypharmacy ( > 4 medications ) or fall risk-increasing medications and subsequent falls or injurious falls was assessed using modified Poisson regression . The association with the number of falls was assessed using negative binomial regression . RESULTS during follow-up , 231 falls per 1,000 person-years were reported . Polypharmacy including antidepressants was associated with a greater risk of any fall ( adjusted relative risk ( aRR ) 1.28 , 95 % CI 1.06 - 1.54 ) , of injurious falls ( aRR 1.51 , 95 % CI 1.10 - 2.07 ) and a greater number of falls ( adjusted incident rate ratio ( aIRR ) 1.60 , 95 % CI 1.19 - 2.15 ) , but antidepressant use without polypharmacy and polypharmacy without antidepressants were not . The use of benzodiazepines was associated with injurious falls when coupled with polypharmacy ( aRR 1.40 , 95 % CI 1.04 - 1.87 ) , but was associated with a greater number of falls ( aIRR 1.32 , 95 % CI 1.05 - 1.65 ) , independent of polypharmacy . Other medications assessed , including antihypertensives , diuretics and antipsychotics , were not associated with outcomes . CONCLUSION in middle-aged and older adults , polypharmacy , including antidepressant or benzodiazepine use , was associated with injurious falls and a greater number of falls General practice p 994 Older people frequently fall . This is a serious public health problem , with a substantial impact on health and healthcare costs.1 These guidelines translate trial evidence about prevention of falls into recommendations that can be implemented in different setting s , with the aim of reducing the rate of falls and injurious falls in people over 65 ( see boxes 2 3 ) . # # # # Summary points Multifaceted interventions reduce falls in older people ( those over 65 ) Home assessment of older people at risk of falls without referral or direct intervention is not recommended Assessment of high risk residents in nursing homes with relevant referral is effective Evidence from well design ed single trials shows that assessment and modification of risk factors of older people who have presented to an accident and emergency department after a fall and the provision of hip protectors in residents of nursing homes are effective We up date d two previous systematic review s to include any new evidence up to March 1998 . 4 5 We electronically search ed Medline for all r and omised controlled trials and systematic review s by using the terms fall(s ) , accidental falls , fracture , elderly , aged , older , and senior . We followed up relevant references in papers , and we contacted research ers in prevention of falls for information about other trial evidence and about studies from journals not catalogued by the National Library of Medicine . For inclusion , studies had to be r and omised controlled trials of interventions design ed to minimise or prevent exposure to the risk factors for falling ( or fracture ) in people aged 65 years or over living in either community or residential care . Outcomes had to include the number of people who had fallen or the number of falls or fractures . We excluded drug or dietary treatments for the prevention of fractures . Trials that fulfilled the inclusion criteria were review ed and summarised OBJECTIVES The aims of this study were to determine the incidence of falls in a group of elderly patients with diabetes and to assess for the prevalence of risk factors for falls in this population . DESIGN This is a population -based study with question naire-based interviews . SETTING The setting for this study was the London District General Hospital outpatient department . PARTICIPANTS Seventy-seven patients with diabetes , aged over 65 years , r and omly selected whilst attending for general diabetic annual review . Patients with dementia , blindness , and immobility and those who were unable to give informed consent were excluded from this study . MEASUREMENTS The incidence of falls in the last 12 months was used . Information was collected on the incidence of hypoglycaemic episodes , the presence of other medical conditions , visual impairment , and peripheral neuropathy , the use of medications and walking aids , and HbA1C and blood pressure control . RESULTS The incidence of falls was 39 % . Falls occurred more frequently in female patients and patients of increasing age . Falls occurred more frequently in patients with poor diabetic control [ risk ratio (RR)=7.83 ( 2.948 - 20.799 ) , chi2 value=6.422 ] ; patients requiring assistance with mobility : for those mobile with a stick [ RR=1.839 ( 1.048 - 3.227 ) , chi2=4.619 ] ; and those who had previously suffered a stroke [ RR=1.929 ( 1.143 - 3.257 ) , chi2=4.615 ] . CONCLUSION We provide evidence that poorly controlled diabetes and conditions associated with complications of diabetes are associated with an increased risk of falling in older people . We recommend early recognition of the multiple causes of falls in the older diabetic patient and prompt referral of this group of patients to a specialist falls clinic The purpose of this study was to describe  falls and injuries within assisted living ( AL ) communities and determine whether a function-focused care ( FFC ) intervention increased the risk of falls and /or injuries . This was a secondary data analysis using data from a 12-month cluster-r and omized controlled trial in which four AL communities were matched based on ownership and r and omly assigned to treatment ( FFC-AL )  or  attention control ( FFC — education only )  . Demographic information and information on comorbidities , falls , and consequences postfall , ability to ambulate 50 yards , gait and balance , cognition , person – environment fit , and medication use were collected . Logistic regression was used to test the hypotheses . Exposure to FFC-AL did not result in an increased likelihood of falling ( Wald = 0.01 , p = .96 ) or sustaining an injury ( B = 0.42 , Wald = 0.88 , p = .35 ) . The study findings supported prior research findings supporting the safety of interventions that optimize function and encourage physical activity among older adults The purpose of this study was to identify associations between the use of commonly taken medications and groups of medications and the risk of falls in elderly people living in the community . A stratified r and om sample of 1358 persons aged 65 years and over was selected from the 15,000 members of an educational organization for functionally independent , community-dwelling elderly people in St Louis , Missouri . Twenty-seven per cent of subjects reported at least one fall in the past year and 8 % reported two or more falls . After adjusting for potential confounders ( including age , sex , relevant medical conditions , health status , cognitive impairment , use of alcohol , depression and use of other medications ) , the following medications were found to be important risk factors for multiple falls :  diazepam [ odds ratio ( OR ) : 3.7 , 95 % confidence interval ( CI ) : 1.5 - 9.3 ] , diltiazem ( OR : 1.8 , 95 % CI : 0.8 - 4.1 ) , diuretics ( OR : 1.8 , 95 % CI : 1.2 - 2.8 ) and laxatives ( OR : 2.1 , 95 % CI : 1.0 - 4.5 ) . We conclude that caution is needed before prescribing diuretics and psychotropics , especially diazepam , for elderly people . The safety of diltiazem in this age group should be assessed further Background and aims The aim of this study was to describe the prevalence of falls  in a general older population , especially among the most elderly , and the risk markers associated with falls . Methods This is a cross-sectional study in which 38 fall risk markers were analysed in non- , occasional- and frequent-fallers . The population was 2,865 individuals ( aged 60–93 ) , r and omly selected from the general population register . The risk of falling was calculated as age-adjusted odds ratios . The relation between the number of risk markers  for an individual and falls was also analysed . Results About one in ten reported falling during the past 6 months , 35 % of which were over 90 years old . Twenty-one risk markers were significantly related to falls confirming falling as a multifactorial problem . These included a variety of diseases , symptoms , medical and physical functions , life-style factors and the taking of certain drugs . The five risk markers with the highest odds ratio in frequent fallers were ‘ tendency to fall ’ ( 37.9 ) , ‘ low walking speed ’ ( 12.8 ) , consumption of ‘ neuroleptics ’ ( 10.9 ) , ‘ impaired mobility ’ ( 10.0 ) and ‘ dementia ’ ( 5.4 ) . Subjects with more than four and seven risk markers showed a 9- respectively 28-fold increase in the risk of falling , especially among frequent fallers and those aged over 90 years . Conclusion Falls are common in the elderly population and the risk is multifactorial . The results imply that there is an overrepresentation of fallers in a distinct subgroup of the very elderly and those with multiple risk markers . The self-perceived clinical sign ‘ tendency to fall ’ seems highly sensitive as indicator of individuals at risk . Several risk markers may be treatable . Fall risk seems to increase in a non-linear , almost exponential way with increasing number of risk markers The aim of this study was to identify individual predisposing risk indicators for falls in a sample of institutionalized frail elderly in southern Germany . The design was a prospect i ve observational study with a 1-year follow-up ( October 1998-September 1999 ) . The study population included 472 long-term-care residents whose mean age was 84 years ; 77 % were female . Risk indicators for accidental falls were analyzed by using logistic regression . Residents were found to have an incidence density rate of falls of 2,558 per 1,000 resident-years . Multiple logistic regression analysis revealed short-term memory loss , transfer assistance , urinary incontinence , positive fall history , and use of trunk restraints as predictors of falls . In a further logistic regression analysis , depressive symptoms , transfer assistance , urinary incontinence , and positive fall history were associated with frequent falls . Using these risk indicators as a screening procedure to identify fallers would be easy to administer and could be accomplished by nursing staff . Study results encourage specifically addressing urinary incontinence , cognitive impairment , use of restraints , depression , and transfer difficulties as modifiable predisposing risk factors for falls . Fall history represents an important nonmodifiable marker to identify residents at high risk
Conclusions The use of sedatives and hypnotics and antidepressants including tricyclic antidepressants , selective serotonin reuptake inhibitors , and serotonin norepinephrine reuptake inhibitors appears to be related with an increased risk of falls .
It is not clear if the use of antihypertensive medications is associated with the risk of falls in older people
Purpose Falls are an important public health problem in older people .
Medication use is considered a risk factor for falls .
This study systematic ally review ed recent studies to determine the medications that might be associated with the risk of falling in older people .