The Connection Between Antipsychotic Use and Falls in Nursing Homes

Falls are a leading cause of injury and hospitalization among nursing home residents, often leading to long-term disability or even death. Antipsychotic medications represent one of the contributing factors that may be often overlooked. These drugs, though sometimes necessary, can raise the risk of falls substantially, thus affecting both resident safety and facility compliance with CMS guidelines.

How Antipsychotic Medications Increase Fall Risk

 Sedation and Drowsiness

Sedation is one of the most frequent side effects of antipsychotic drugs, and it may cause:

• Drowsiness and fatigue during the day
• Delayed reaction times
• Impaired balance and coordination

Excessive sedation in residents leads to an increased risk of unsteady gait and accidental falls. This risk is especially high during routine activities such as walking to the dining hall or using the restroom.

Orthostatic Hypotension

Antipsychotics frequently induce orthostatic hypotension, a sudden drop in blood pressure upon standing, which may result in:

• Dizziness and lightheadedness
• Fainting spells
• Increased risk of falls when transitioning from sitting to standing

Motor Function Impairment

Antipsychotics, particularly typical (first-generation) antipsychotics, may cause extrapyramidal symptoms (EPS). They include dystonia (involuntary muscle contractions), akathisia (restlessness), Parkinsonism (tremors, rigidity, slow movement), & tardive dyskinesia (involuntary facial movements).

These symptoms are associated with impaired mobility and an increased risk of falls.

Cognitive Decline and Confusion

Sedation and cognitive dulling from antipsychotics can cause confusion and disorientation in residents, which makes them forget to use mobility aids like walkers or canes and attempt risky movements without assistance.

Polypharmacy Complications

Residents often take multiple medications and drug interactions can intensify the sedative effects of antipsychotics, which increases the risk of falls.

The best way to avoid such complications is to monitor residents closely for signs of sedation, dizziness, or unsteady gait, especially after changes in medication regimens.

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The Impact of Falls on Resident Health and Facility Compliance

Health Consequences for Residents

Falls are a leading cause of:

• Hip fractures and other serious injuries
• Hospitalization and prolonged recovery periods
• Decreased mobility and independence
• Fear of falling again, leading to reduced activity levels

Regulatory and Financial Implications

Falls linked to improper antipsychotic use can lead to:

• CMS citations and F-Tags for failure to prevent unnecessary medication use (F605 Chemical Restraints or F758)
• Lower Five-Star Quality Ratings because of resident outcomes and increased hospitalization rates
• Increased liability and potential legal action from families
• Impact on Facility Reputation

High fall rates can damage a facility’s reputation, making it more difficult to attract new residents and retain  staff.

Best Practice: Carry out regular fall risk assessments and review medication lists periodically to identify potentially hazardous  drug interactions.

Best Practices for Reducing Antipsychotic-Related Falls

Comprehensive Fall Risk Assessments

To determine the risk of falls, each resident should undergo a multidisciplinary assessment, considering:

• On admission, monthly and as needed medication
• Physical therapy evaluations to assess strength and balance
• Environmental assessments to identify and mitigate hazards

Gradual Dose Reduction (GDR)

CMS requires Gradual Dose Reduction (GDR) to determine if antipsychotics can be reduced or discontinued without adversely affecting the resident.

Steps to Implement GDR:

• Pharmacist should review a resident's medications monthly and identify medications appropriate for GDR. If the physician agrees or disagrees, documentation must be completed as to why a GDR was completed or not completed.
• Attempt GDR at least twice in the first year of treatment, then annually
• Monitor residents closely for behavioral changes or withdrawal symptoms

Use Non-Pharmacological Interventions

Before resorting to antipsychotic medications, explore non-drug interventions:

• Exercise and physical therapy programs to strengthen muscles and improve balance
• Sensory stimulation activities to reduce agitation
• Environmental modifications such as adequate lighting and clear walkways

Staff Training on Fall Prevention

Ensure that staff are trained in:

• Recognizing early signs of sedation or motor impairment
• Conducting safe transfers and mobility assistance
• Resident participation in exercises for fall prevention.

Family Education and Involvement

Educate families regarding antipsychotic medication risks and actively engage them to determine alternative non-drug treatment plans.

Best Practice: The facility maintains open communication about medication plans to family members and ensures they take part in decisions about non-drug treatments.

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Antipsychotic medications create substantial fall risks in nursing homes which results in severe injuries and regulatory sanctions as well as diminished quality of life for residents.  The implementation of best practices regarding medication management and fall prevention strategies enables nursing homes to provide better safety and well-being for their residents.

A partnership between nursing homes and Qsource leads to safer residents and better-quality care alongside regulatory compliance maintenance.