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Anticonvulsants Raise Risk of Falls in LTC : Total 'anticholinergic load,' as well as anticonvulsant use, correlates with reported falls.


RIO GRANDE, PUERTO RICO — Anticholinergic use correlated with falls in a case-control study of 268 long-term care residents.

Because anticholinergic medications are known to slow down psychomotor responses, University of Cincinnati medical student Becky Yu-Chi Huang and her colleagues hypothesized that the more of these medications residents took, the more likely they would be to fall. The team noted that in long-term care facilities in general, falls are a “major problem,” with an average of about 1.5 incidents per resident each year.

The researchers compared medication profiles of 134 long-term care residents who had frequent falls with the medication profiles of 134 residents who had no reported falls in the past 6 months. The average age of the residents was 86 years, and 84% were women. Short-term residents and people with diagnoses of acute stroke or seizure disorders were excluded from the study.

For each person, the researchers calculated an “anticholinergic load,” with medications such as amitriptyline and carisoprodol scored at 3, cetirizine and baclofen scored at 2, and divalproex and furosemide scored at 1. Categories of drugs contributing to anticholinergic load included antihistamines, muscle relaxants, opioids, gastrointestinal medications, urinary incontinence medications, cardiac medications, anticonvulsants, tricyclic antidepressants, other antidepressants, and antipsychotics.

Overall, at least one fall in a 6-month period was significantly correlated with a greater anticholinergic load, based on chi-square tests and regression analysis.

When the medications were analyzed by subgroup, only an increased use of anticonvulsants correlated with an increased number of falls, the investigators noted. They added that anticonvulsant medications can contribute to falls by causing dizziness, gait disorder, and sedation. The team reported its findings in a poster at the annual meeting of the North American Primary Care Research Group.

The results highlight the need to review medication use in long-term care residents with a history of falling, said Harold Bob, MD, CMD, president of the Maryland Medical Directors Association and a member of the AMDA Clinical Practice Committee. “Each medication may of itself be necessary for treatment of a symptom that itself enhances fall risks,” he explained. “For example, anticholinergic medication may be present in simple eye drops, but stopping these medications may decrease vision and increase falls.

“When patients get on nine or more medications, doctors should consider medication reduction,” said Dr. Bob. But he cautioned that there are no sure answers, because stopping medications can also cause problems.

Dr. Bob noted that nursing home staff also must balance concerns about falls with maintaining the residents' quality of life. “Sometimes families want me to restrain patients to prevent falls, and we cannot do this. I stress the interdisciplinary approach taken in the AMDA Practice Guideline: Falls and Fall Protection, and the AMDA Clinical Corner on Falls and Fall Risks,” he said.

The study was limited by the use of only falls reported by staff members and by a lack of information on the duration of medication use, Ms. Huang and her colleagues noted.

“An attempt should be made to eliminate any potentially unnecessary medications with anticholinergic properties,” the investigators said. “This may reduce the incidence of future falls.”

Ms. Huang disclosed no financial conflict. Her colleague, Dr. Arvind Modawal, has served on the speakers bureau for Merck & Co. but claimed no conflict of interest for this study.

Heidi Splete is a senior writer with Elsevier Global Medical News.

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