New loop diuretic prescriptions may be an acute risk factor for falls in the 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.