Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults

Objective To investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults. Methods We performed a nationwide matched (age, sex, and case event day) case–control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co‐morbidity index, dementia and number of other drugs. Results Antidepressants were the psychotropic most strongly related to fall injuries (OR adjusted : 1.42; 95% CI: 1.38–1.45) and antipsychotics to hospitalizations (OR adjusted : 1.22; 95% CI: 1.19–1.24) and death (OR adjusted : 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: OR adjusted : 1.53; 95% CI: 1.39–1.68), hospitalization (4 psychotropics vs 0: OR adjusted : 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: OR adjusted : 2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n = 58,984), a dose–response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: OR adjusted : 1.99; 95% CI: 1.76–2.25). Conclusions Our findings support a cautious prescribing of multiple psychotropic drugs to older patients.