Atypical Antipsychotic Medications and Risk of Falls in Residents of Aged Care Facilities

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 53; no. 8; pp. 1290 - 1295
• Main Authors: Hien, Le T. T., Cumming, Robert G., Cameron, Ian D., Chen, Jian S., Lord, Stephen R., March, Lyn M., Schwarz, Jennifer, Le Couteur, David G., Sambrook, Philip N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Inc 01.08.2005; Blackwell; Wiley Subscription Services, Inc
• Subjects: Accidental Falls; Aged; aged care; Aged, 80 and over; Antipsychotic Agents - therapeutic use; Antipsychotic drugs; antipsychotics; Benzodiazepines - therapeutic use; Biological and medical sciences; Cohort Studies; Falls; Female; General aspects; Homes for the Aged; Humans; Male; Medical sciences; Nursing Homes; Olanzapine; Older people; Prescription drugs; Prevention; Prospective Studies; Psychotropic drugs; psychotropic medications; Risk factors; Risperidone; Risperidone - therapeutic use; Australia, New South Wales, Sydney; Atypical antipsychotic; Olanzapine; Neuroleptic; Psychotropic; Risk; Serotonine receptor; accidental falls; antipsychotics; Risperidone; Nursing home; Human; Drug; Dopamine antagonist; Serotonin antagonist; psychotropic medications; Thienobenzodiazepine derivatives; Care; Chemotherapy; Gerontology; D2 Dopamine receptor; Treatment; Risk factor; Fall; Elderly; aged care; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2005.53403.x

Objectives: To determine whether use of atypical antipsychotics (olanzapine and risperidone) is associated with lower risk of falls than use of typical antipsychotics. Design: Prospective cohort study with 1‐month follow‐up. Setting: Residential aged care facilities in Sydney, Australia. Participants: Two thousand five people aged 65 to 104 (mean age 86). Measurements: Medication use at baseline was collected from medical records. Data on potential confounders were collected at interview and physical examination and from medical records. The outcome was accidental falls (one or more). Results: One thousand one hundred seven subjects (55%) used at least one type of psychotropic medication, with 289 (14%) using an antipsychotic. There were 82 olanzapine users, 38 risperidone users, and 181 users of typical antipsychotics. Eleven percent of subjects (n=226) had at least one fall during follow‐up. After adjusting for a comprehensive range of falls risk factors, hazard ratios (HRs) for falls were 1.35 (95% confidence interval (CI)=0.87–2.09) for typical antipsychotics, 1.32 (95% CI=0.57–3.06) for risperidone, and 1.74 (95% CI=1.04–2.90) for olanzapine. Antidepressants were also associated with falls (adjusted HR=1.45, 95% CI=1.09–1.93). Conclusion: Despite fewer extrapyramidal side effects, atypical antipsychotic medications are not associated with fewer falls than the older, more‐established antipsychotics.