Are psychotropic medications equivalent in fall risk among nursing home residents? A meta-analysis of pharmacologic subtypes and polypharmacy effects.

BACKGROUND AND

OBJECTIVE

Falls are a major concern for nursing home residents, and psychotropic medications are key risk factors. However, the differential fall risk among pharmacologic subtypes remains unclear, as exemplified by the comparison of typical and atypical antipsychotics, which impedes precise medication safety management. The aim of this study is to compare the fall risk across specific pharmacologic subgroups of psychotropic medications in nursing home residents through a systematic review and meta-analysis.

METHODS

This systematic review and meta-analysis involved comprehensive searches of nine databases for observational studies assessing medication use and fall risk in older nursing home residents. Study quality was appraised using standardized tools, and data were pooled using random-effects models.

RESULTS

Twenty studies were included. Meta-analysis showed that the use of typical antipsychotics (OR = 1.66, 95% CI: 1.25-2.21), atypical antipsychotics (OR = 1.78, 95% CI: 1.48-2.13), long-acting sedative-hypnotics (OR = 1.43, 95% CI: 1.13-1.82), short-acting sedative-hypnotics (OR = 1.39, 95% CI: 1.07-1.55), antidepressants (OR = 1.55, 95% CI: 1.33-1.81), and polypharmacy (OR = 1.64, 95% CI: 1.24-2.12) were all significantly associated with increased odds of falling. Subgroup analysis indicated no statistically significant higher fall risk for atypical compared to typical antipsychotics (P>0.05), and the difference between long-acting and short-acting sedative-hypnotics was not significant.

CONCLUSIONS

All categories of psychotropic medications significantly increase fall risk in nursing home residents, with atypical antipsychotics posing a potentially higher risk. This study underscores the necessity of distinguishing risk among pharmacologic subtypes for precise risk management and provides critical evidence for informing safer prescribing practices to prevent falls.