Psychotropics Use and Occurrence of Falls in Hospitalized Patients: A Matched Case-Control Study

Background Preventing in-hospital falls is a critical issue in medical safety management, and identifying risk factors for falls is essential. Previous studies have investigated the association between the use of psychotropics and falls, although most were registry-based studies with limitations, such as inaccurate identification of fall outcomes and lacked information on the time interval between the use of psychotropics and the occurrence of falls. Therefore, no clear consensus exists on whether the use of psychotropics is a risk factor for in-hospital falls. Aims & Objectives The aim of this study was to evaluate the association between the use of psychotropics and the occurrence of falls in hospitalized patients. Method A retrospective matched case-control study was conducted on adult patients admitted to every department of Tokyo Medical University Hospital in Tokyo, Japan. A new-user design was applied, prevalent users (patients who had used one or more psychotropics during the first two days after admission) were excluded. The outcome was the occurrence of an in-hospital fall. All in-hospital falls between January 2016 and December 2016 were identified from incident reports. A total of 254 hospitalized patients who had in-hospital falls at some point in their hospitalization during the study period were included as cases. For each case, hospitalized patients without falls were matched by age (± 3 years), sex, and inpatient department using electronic medical records. Among the listed control candidates, 254 controls were randomly selected with a ratio of case: control = 1: 1. All data were extracted from electronic medical records. The four classes of psychotropics used on the day before an in-hospital fall were analyzed as exposure for falls. Additionally, the types of hypnotics used on the day before an in-hospital fall were analyzed as exposure for falls. Logistic regression analyses were conducted to evaluate the association between the use of psychotropics and the occurrence of falls. The multivariable logistic regression model adjusted for age, sex, inpatient department, body mass index, total score on the fall risk assessment sheet, and the use of other psychotropics. The study was approved by the Institutional Review Board of Tokyo Medical University. Results The multivariable logistic regression analysis showed that the use of hypnotics (odds ratio [OR] = 2.223; 95% confidence interval [CI] = 1.249 to 3.956), but not the use of antipsychotics, antidepressants, and anxiolytics, was significantly associated with an increased OR of in-hospital falls. Additionally, the multivariable logistic regression analysis of the types of hypnotics showed that the use of benzodiazepines (OR = 6.585; 95% CI = 2.179 to 19.905), but not the use of non-benzodiazepines, was significantly associated with an increased OR of in-hospital falls. Discussion & Conclusions The use of hypnotics was identified as a risk factor for falls among hospitalized patients. Furthermore, the use of benzodiazepine hypnotics was suggested to be a risk factor for in-hospital falls. Minimizing the frequency in the use of hypnotics, particularly benzodiazepines, might contribute to decreasing the rate of falls in hospitalized patients.