“Inappropriate use” of psychotropic drugs linked to fall risk: study

A team of Australian researchers are calling for a review into the use of psychotropic medications in aged care, revealing a significant link between their use and fall risk.

The paper, published in BMJ Journals, conducted a retrospective longitudinal cohort study using health data collected from over 3,000 residents aged 65 and over, across 23 Sydney-based residential aged care facilities, and found that regular medication reviews are crucial to reducing falls among older adults.

First author Narjis Batool told Aged Care Insite that the side effects of psychotropic drugs, such as sedation, orthostatic hypotension, dizziness, confusion, and sleep disturbances, contribute to a heightened fall risk.

“Our study found that 40 per cent of residents used at least one potentially inappropriate psychotropic medication over a two-year period. Among those who received these medicines, 70 per cent experienced at least one fall, and one in three of those falls resulted in a hospital transfer.”

In Australia, people living in residential aged care experience mental health issues at higher rates than the general older adult population, with over half of all residents experiencing depression.

This has lead to the widespread use of psychotropic medicines, such as antidepressants and antipsychotics, in aged care, and while these drugs can help in managing anxiety, insomnia, and depression, they also affect the central nervous system, significantly increasing the risk of falls.

Furthermore, falls have become the leading cause of injury hospitalisation in the nation, costing the public health system billions of dollars each year.

“This is especially problematic in residential aged care facilities, where residents are already more vulnerable due to frailty, reduced mobility, or cognitive impairment,” Ms Batool explained.

“The combination of age-related risk factors and medication side effects significantly increases the likelihood of falls. In turn, falls in these settings can lead to serious injuries, hospitalisations, and a decline in overall health and quality of life.”

Calls for a review

The study advocates for regular medication reviews to prevent or reduce the “potentially inappropriate use” of psychotropic drugs, referring to situations where medication is prescribed without a strong clinical justification, are used for extended periods without review, or are given in ways that may cause more harm than benefit.

Ms Batool said there are safer, non-pharmacological alternatives available to treat conditions like pain, loneliness or depression.

“Looking ahead, we’d like to see aged care providers adopt proactive medication management systems – – including routine medication reviews, stronger clinical oversight, better staff training, and a shift toward person-centred, non-drug interventions,” she said.

“Medication reviews can assist clinicians and care staff in identifying residents who may have been on medication longer than recommended.

“Management should also consider providing training to help staff recognise residents at risk of falls and implement effective fall prevention strategies. These strategies could include exercise programs to enhance residents’ strength and balance, as well as improvements in lighting to minimise the risk of trips.”

Related: Half of Australians in aged care have depression. Psychological therapy could help | Falls cause 43% of injury hospitalisations. Here’s how to better predict and prevent them