A delicate balance: Psychotropic polypharmacy and anti‐cholinergic use are correlated with fall incidence in Australian inpatients with dementia

• Main Authors: Samuel X. Tan, Sarah C. Cameron, Lit Min Sam, Hugh Eigeland, Karen Hay, Eamonn Eeles, Kannan Natarajan
• Format: Article
• Language: English
• Published: Wiley 2021-09-01
• Series: Aging Medicine
• Subjects: antidepressant; dementia; falls; neuropsychiatry; psychotropic
• Online Access: https://doi.org/10.1002/agm2.12175

Abstract Background Persons with dementia commonly experience a range of behavioural and psychological symptoms, including agitation, aggression, perceptual disturbances, and depression. While psychotropic medications are regularly prescribed to mitigate these symptoms, these agents also carry a broad adverse effect profile. This study aimed to characterize psychotropic medication use in patients with dementia, as well as identify prescribing factors associated with falls in this cohort. Methods This retrospective study collected longitudinal demographic and medication data from all patients admitted to a neuro‐cognitive unit at an Australian metropolitan hospital over a 2‐year period. Psychotropic polypharmacy and psychotropic agent use per patient‐fortnight were investigated for their association with inpatient falls. Results All patients (n = 147) were prescribed at least one psychotropic medication, with 96% receiving anti‐psychotic medications and 90% receiving benzodiazepines. Patient fall rate was significantly associated with anticholinergic drug use (Incidence rate ratio: 2.2; P < .001), as well as concomitant use of ≥5 daily psychotropic agents (Incidence rate ratio: 3.1; P = .001). Conclusions Patients with dementia are routinely prescribed a wide variety of psychotropic medications. Use of anticholinergic drugs and psychotropic polypharmacy are correlated with fall incidence in persons with dementia.