Antipsychotic and Benzodiazepine Drug Changes Affect Acute Falls Risk Differently in the Nursing Home

J Gerontol A Biol Sci Med Sci. 2016 Feb;71(2):273-8. doi: 10.1093/gerona/glv091. Epub 2015 Aug 5.


Background: Psychotropic drugs increase the risk of falls, but they are still frequently prescribed to treat behavioral symptoms associated with dementia in the nursing home. We examined whether there is an acute increased risk of falls in the days following a change to an antipsychotic or benzodiazepine drug prescription.

Methods: We collected information on 594 long-stay nursing home residents from two facilities who fell at least once between September 1, 2010 and May 31, 2013. Psychotropic drug changes were ascertained from the facilities' computerized medication administration log. We used the case-crossover design to compare the frequency of antipsychotic and benzodiazepine drug changes during the days before a fall with the frequency of drug changes at more remote times.

Results: Mean age was 87.5 years, and 75.1% were female. The risk of falls was higher in the 24 hours following benzodiazepine initiation compared with other times (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.10, 13.00). There was no clear difference in risk following antipsychotic initiation (OR 2.42, CI 0.58, 10.06), but this could be due to the small sample size. Stopping a benzodiazepine was associated with a significantly reduced fall risk (OR 0.26, 95% CI 0.08-0.91).

Conclusions: Benzodiazepines pose an immediate threat to fall risk, whereas it is less clear if antipsychotics also pose an immediate risk. Nursing home staff should be particularly vigilant in the days following the new prescription for a benzodiazepine in an effort to prevent injury.

Keywords: Antipsychotic; Benzodiazepine; Drug change; Falls; Nursing home.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Accidental Falls / statistics & numerical data*
  • Aged
  • Antipsychotic Agents / administration & dosage
  • Antipsychotic Agents / therapeutic use*
  • Benzodiazepines / administration & dosage
  • Benzodiazepines / therapeutic use*
  • Cross-Over Studies
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Male
  • Nursing Homes*


  • Antipsychotic Agents
  • Benzodiazepines