More Than Psychotropic Medications, Neuropsychiatric Symptoms (NPS) Help Predict Fall Risk

September 22, 2020

Even with long-term care (LTC) facility residents in quarantine due to the COVID-19 pandemic, falls continue to be a concern. Impaired mobility, the use of psychotropic drugs, anxiety, depression, and orthostatic hypotension all have been shown to increase fall risk. Now a new study in the September issue of JAMDA suggests neuropsychiatric symptom (NPS) severity may predict falls and fall-related negative consequences.

In Neuropsychiatric Symptoms as Predictors of Falls in Long-Term Care Residents with Cognitive Impairment, Hanna-Maria Roitto, MD, and colleagues studied 532 LTC residents aged 65 and older. Participants were measured with the Neuropsychiatric Inventory (NPI) as a baseline.  The numbers of falls, injuries, factures, and hospitalizations were collected from medical records over 12 months following baseline assessment. In total, 606 falls occurred the follow-up year, with 121 injuries, 42 hospitalizations, and 20 fractures.

Falls and injuries increased significantly with NPS burden; specifically, psychosis and hyperactivity were associated with a higher incidence of falls. The authors also say, “Our study suggests that in this special long-term care population with severe cognitive impairment, the NPS burden is more important in determining falls than psychotropic drug use.”

The authors conclude, “The findings of this study indicate that evaluation of NPS, and especially severity of NPS, and NPS subgroups should be part of the comprehensive assessment when aiming to prevent falls in long-term care residents with cognitive impairment.” They also note, however, that most falls are not the result of a single cause; thus, a multifactorial approach to fall prevention is recommended.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.