Brief Report

New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home†

  1. Sarah D. Berry1,*,
  2. Murray A. Mittleman2,
  3. Yuqing Zhang3,
  4. Daniel H. Solomon4,
  5. Lewis A. Lipsitz1,
  6. Elizabeth Mostofsky2,
  7. Dana Goldense1,
  8. Douglas P. Kiel1

Article first published online: 15 MAR 2012

DOI: 10.1002/pds.3256

Issue

Pharmacoepidemiology and Drug Safety

Pharmacoepidemiology and Drug Safety

Volume 21, Issue 5, pages 560–563, May 2012

Additional Information

How to Cite

Berry, S. D., Mittleman, M. A., Zhang, Y., Solomon, D. H., Lipsitz, L. A., Mostofsky, E., Goldense, D. and Kiel, D. P. (2012), New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home. Pharmacoepidem. Drug Safe., 21: 560–563. doi: 10.1002/pds.3256

Author Information

  1. 1

    Hebrew SeniorLife Institute for Aging Research and Beth Israel Deaconess Medical Center Division of Gerontology, Boston, MA, USA

  2. 2

    Department of Medicine, Beth Israel Deaconess Medical Center Cardiovascular Epidemiology Research Unit, Boston, MA, USA

  3. 3

    Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA

  4. 4

    Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA

*S. Berry, Hebrew SeniorLife Institute for Aging Research and Beth Israel Deaconess Medical Center Division of Gerontology, Boston, MA USA 02131.
E-mail: sarahberry@hsl.harvard.edu

  1. †

    This work was presented in part at the 2011 annual meeting of the American Geriatrics Society in National Harbor, MD, USA, on 14 May 2011.

Publication History

  1. Issue published online: 18 APR 2012
  2. Article first published online: 15 MAR 2012
  3. Manuscript Accepted: 15 FEB 2012
  4. Manuscript Revised: 25 JAN 2012
  5. Manuscript Received: 26 OCT 2011

Funded by

  • Hartford Geriatrics Health Outcomes Research Scholars Award. Grant Numbers: K23 AG033204, T32-HL098048
  • Men's Associates of Hebrew SeniorLife

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (97K)

Keywords:

  • diuretic;
  • fall;
  • nursing home

ABSTRACT

Purpose

Although chronic use of diuretics has been implicated as a risk factor for falls, it is unknown whether changes in diuretic drugs are associated with an acutely elevated risk of falls. We evaluated the relationship between change in a diuretic prescription (new prescription or increased dose) and the occurrence of documented falls among nursing home residents.

Methods

Participants of the cohort were 1785 long-term care residents of two large nursing homes (2005–2010; Boston, MA). A self-matched, case-crossover analysis was used to examine whether there is an acutely increased risk of falling in the day following a diuretic drug change compared with days without a diuretic drug change. Odds ratios with 95% confidence intervals were calculated using conditional logistic regression models.

Results

During a mean follow-up of 8.4 months, 1181 participants experienced an incident fall. Nine participants experienced a diuretic change on the day before the fall. The odds of falling one day following a change in a diuretic was elevated (OR = 2.08; 95%CI = 0.89, 4.86). The association was stronger and reached nominal statistical significance when loop diuretics were examined separately (OR = 2.46; 95%CI = 1.02, 5.92). We estimated that, for every 271 loop diuretic drug changes, one excess fall occurred.

Conclusions

Nursing home residents are at an increased risk of falls in the day following a new prescription or increased dose of a loop diuretic drug. Extra precautions should be taken immediately following a loop diuretic drug change in an effort to prevent falls. Copyright © 2012 John Wiley & Sons, Ltd.

View Full Article (HTML) Get PDF (97K)