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

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.

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.

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.

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.