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Sedatives put elderly at high risk of falling

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Giving fewer sedatives to elderly residents in care homes could significantly reduce the number of falls, suggests a Swedish study.

The findings, which have drawn criticism that GPs are too eager to prescribe the drugs, follow recent concern over their use in the UK.
Researchers analysed 2,343 falls and fractures reported at 21 nursing homes over four years. All affected residents had been diagnosed with a physical illness, dementia or both.
The results suggests those given antipsychotics were almost twice as likely to have a fall than those not taking them. Residents taking sleeping pills containing benzodiazepines had almost three times the risk of falling. Benzodiazepines were also linked with a considerable number of fractures.
Last month the all-party parliamentary group on dementia launched an inquiry into the use of sedatives in patients with dementia after the Alzheimer’s Society claimed they had ‘minimal benefit and dangerous side-effects’ (NT News, 11 December, p3).
Jonathan Webster, nurse consultant for older people at University College London Hospital, said: ‘There is the potential for these medications to be used inappropriately – oversedating is still restraint but in a chemical rather than physical form.’
He added: ‘[Sedatives] should only be given after an individual, evidence-based risk assessment has taken place.’
Frank Ursell, chief executive officer of the Registered Nursing Home Association, said: ‘There is a culture with GPs to prescribe, prescribe, prescribe – and they are all too quick to adopt a one-size-fits-all approach.’
The authors also found that the selective use of physical restraints, such as wheelchairs and safety belts, reduced falls.
The Commission for Social Care Inspection guidelines say restraint should only be used
in emergencies and its inappropriate use is unlawful.

Journal of Clinical Nursing (2008) 17: 126–134

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