Psychotropic medication and fall among inpatients at a Hong Kong psychiatric hospital

To determine the associations between psychotropic medications and falls among adult psychiatric inpatients.

This study retrospectively reviewed fall incidents among adult psychiatric inpatients at Kwai Chung Hospital between 1 January 2019 and 31 December 2024. Falls secondary to acute medical events (eg, cardiac arrest or seizures) were excluded. An operational definition of >4 medications for general polypharmacy and >3 psychotropic medications for psychotropic polypharmacy was used. Fall severity was categorised as severity category (SC) 1, which refers to minor injuries resulting in no or simple treatment, or SC2, which includes injuries that require surgical treatments.

In total, 67 SC1 and 58 SC2 falls occurring in 86 female and 39 male inpatients (mean age, 51.8 years) were included in the analysis. Among the 125 inpatients, 64 (51.2%) had general polypharmacy alone, one had psychotropic polypharmacy alone (0.8%), and 35 (28.0%) had both. In univariable logistic regression analysis, SC2 falls were associated with general polypharmacy (odds ratio [OR] = 3.69, p = 0.010), psychotropic polypharmacy (OR = 2.73, p = 0.014), number of psychotropic medications (OR = 1.45, p = 0.023), and number of anticonvulsants (OR = 1.94, p = 0.012).

General polypharmacy, psychotropic polypharmacy, and anticonvulsant use are associated with increased severity of fall-related injuries in adult psychiatric inpatients. These findings underscore the importance of medication review and fall prevention strategies for at-risk patients.