Evaluation of Psychotropic Drugs and Falls among Discharged Elderly Patients in Sana’a City, Yemen

Background: In the elderly, falls are a common and important problem. One of the most feared consequences of falling is a hip fracture. Psychotropic drugs are used extensively among older people and there is a risk of falling that these drugs are used long-term and off-label. In addition to treatment of mental health problems such as depression, anxiety, and insomnia, with psychotropic drugs, these drugs are also prescribed to older patients for behavioral and psychological symptoms of dementia (BPSD). Aims of the study: To investigate whether psychotropic drugs are associated with an increased risk of fall injuries in older adults. Materials and Methods: A retrospective cross-sectional study was conducted on 170 discharge prescriptions of neurosurgery department from Mar 2022 to May 20202. In the present study, the elderly patients of 65 years and above were included in this study. The relevant data were collected from computerized records of a teaching hospital in Sana’a, Yemen. The prescriptions were evaluated and reviewed for investigate whether psychotropic drugs are associated with an increased risk of fall injuries. The obtained data was analyzed using descriptive statistics SPSS version 26. Categorical variables were presented as frequencies and percentages. Also, data were analyzed by chi-square test to know the relationship between the poly-pharmacy and major drug-drug interactions. A value of P-value > 0.05 was considered statistically significant. Results: A total of 170 discharge prescriptions were enrolled. 99 (58.3%) were male patients and 71 (41.8%) were female. It was showed that the major morbidity pattern was depression 79 (46.5). It had been found that (14 drugs) were drugs that generally should be avoided in older adults. The benzodiazepines were the most. The drugs that should be used with caution when prescribe to older adults were 6 drugs and the antidepressant SSRI was the most. Drugs to be avoided or dosage reduced with varying levels of kidney function were 3 drugs on discharge based on AGS 2019. According to the study results, 16.5% of patients had poly-pharmacy on discharge and 83.5% with no poly-pharmacy. The study results revealed that 62 (25.3%) of patients had at least one major drug-drug interactions on discharge. The most common drug-drug interaction was between antidepressant drugs (amitriptyline) with benzodiazepines (lorazepam) which result increase of falls and injuries. The relationship between poly-pharmacy at discharge and major drug-drug interaction was statistically significant in this study. Conclusion: This study showed a high prevalence of PIMs which are mostly psychotropic drugs that should be avoided or used with caution among older patients. Also, this study identifies the major drug-drug interactions that make falls and injures. Poly-pharmacy and chronic conditions were predictors for increased use of PIMs among older patients. Increase the knowledge about PIMs, psychotropic drugs and their potential side effects among patients and healthcare providers is warranted.