Background: Falls are a major health problem among the elderly, particularly in nursing homes. Abnormalities of balance and gait, psychoactive drug use, and dementia have been shown to contribute to fall risk. Methods: We conducted a systematic review of the literature to investigate which psychoactive drugs increase fall risk and what is known about the influence of these drugs on gait in nursing home residents with dementia. We included studies with a prospective cohort design on psychoactive drug use in nursing homes with dementia residents and with falls as an outcome measure. Results: Seventeen studies were included in the review. Pooled risk estimates were not calculated because there was no homogeneity across studies. We assessed the strength of evidence for psychoactive drugs as a prognostic factor for falls by defining four levels of evidence: strong, moderate, limited or inconclusive. Strong evidence was defined as consistent findings (≥80%) in at least two high quality cohorts. We found strong evidence that the use of multiple drugs (3/3 cohorts, effect sizes 1.30-1xs0.30), antidepressants (10/12 cohorts, effect sizes 1.10-7.60), and anti-anxiety drugs (2/2 cohorts, effect sizes 1.22-1.32) is associated with increased fall risk. The evidence for the association of other psychoactive drug classes with fall risk was limited or inconclusive. Conclusions: Research on the contribution of psychoactive drugs to fall risk in nursing home residents with dementia is limited. The scarce evidence shows, however, that multiple drugs, antidepressants and anti-anxiety drugs increase fall risk in nursing home populations with residents with dementia.

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Keywords Accidental Falls, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, Falls, Female, Gait, Humans, Male, Nursing Homes, Nursing homes, Prognosis, Psychoactive drugs, Psychotropic Drugs, Randomized Controlled Trials as Topic, Risk Factors, amitriptyline, antidepressant agent, anxiolytic agent, benzodiazepine, dementia, doxepin, drug effect, drug elimination, drug half life, drug use, fall risk, fall risk assessment, falling, fluoxetine, follow up, gait, gait disorder, human, hypnotic sedative agent, imipramine, nortriptyline, nursing home patient, olanzapine, outcome assessment, paroxetine, psychotropic agent, review, risperidone, scoring system, sedative agent, serotonin uptake inhibitor, sertraline, side effect, systematic review, tranquilizer, trazodone, tricyclic antidepressant agent
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Journal International Psychogeriatrics
Sterke, C.S, Verhagen, A.P, van Beeck, E.F, & van der Cammen, T.J.M. (2008). The influence of drug use on fall incidents among nursing home residents: A systematic review. International Psychogeriatrics (Vol. 20, pp. 890–910). doi:10.1017/S104161020800714X