A delicate balance: Psychotropic polypharmacy and anti‐cholinergic use are correlated with fall incidence in Australian inpatients with dementia

BACKGROUND: Persons with dementia commonly experience a range of behavioural and psychological symptoms, including agitation, aggression, perceptual disturbances, and depression. While psychotropic medications are regularly prescribed to mitigate these symptoms, these agents also carry a broad adverse effect profile. This study aimed to characterize psychotropic medication use in patients with dementia, as well as identify prescribing factors associated with falls in this cohort. METHODS: This retrospective study collected longitudinal demographic and medication data from all patients admitted to a neuro‐cognitive unit at an Australian metropolitan hospital over a 2‐year period. Psychotropic polypharmacy and psychotropic agent use per patient‐fortnight were investigated for their association with inpatient falls. RESULTS: All patients (n = 147) were prescribed at least one psychotropic medication, with 96% receiving anti‐psychotic medications and 90% receiving benzodiazepines. Patient fall rate was significantly associated with anticholinergic drug use (Incidence rate ratio: 2.2; P < .001), as well as concomitant use of ≥5 daily psychotropic agents (Incidence rate ratio: 3.1; P = .001). CONCLUSIONS: Patients with dementia are routinely prescribed a wide variety of psychotropic medications. Use of anticholinergic drugs and psychotropic polypharmacy are correlated with fall incidence in persons with dementia.