Psychotropic Medications and Fall Risk for Nursing Home Residents
Psychotropic medications can help manage certain conditions, but they also increase the risk of dangerous falls in older adults. In this episode, nursing home abuse lawyer Rob Schenk welcomes guest Amanda Meivogel to explore the connection between these drugs and fall injuries, and to share strategies for safer medication management.
Meivogel:
Let somebody know that, hey, my mom’s off balance today. One of the recommendations on the fears list for Seroquel is it can cause infections also. So when a patient has infections, they exhibit other si, like off balance and fevers and things like that.
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I will be your host for this particular episode. Today we are talking about how psychotropic drugs increase the risk of falls. What are the characteristics of the psychotropic drug what do they do to the body that would make individual resident more inclined to fall down.
But we’re not having that conversation alone. We have the fantastic Amanda. My Vogel. My Vogel. That was, that. Had to phonetically spell that out so that I would say it correctly. But she’s gonna be on the show to walk us through that particular subject. But for now, it’s time for the nursing home regulation question of the week.
We’re not having that conversation alone. We got Amanda, my Goul. On the show, Amanda brings over 20 years of healthcare experience, beginning as a certified nursing assistant before becoming a nurse. She has devoted her career to caring for older adults across settings such as nursing homes, emergency departments, home health, and research.
Today, Amanda continues her work in the emergency department, reviews, medical cases, and pursues ongoing education, demonstrating her lasting commitment to improving care for an aging population. We’re so happy to have Amanda on the show. Amanda, welcome to the show.
Meivogel:
Good morning. Thanks for having me.
What is a psychotropic drug?
Schenk:
Amanda, let’s cue up a softball question for you. Since we’re gonna be talking about psychotropic medications in nursing homes, let’s first define what does that mean?
Meivogel:
A psychotropic drug is any drug that can alter your mind or mood. They work on the neurotransmitters in your brain to control.
What is the Beers List?
Schenk:
Okay, so then I guess what, why would a drug like this be prescribed to somebody in a nursing home?
What kind of treatment are we giving? What kind of behavior are we trying to affect?
Meivogel:
Specifically in the nursing homes, they have a lot of dementia units. It’s an off-label use for, to control the behaviors like verbal aggression their moods just behaviors where they couldn’t stay in their home. So these patients are giving, are given these medications. To stabilize and make them normal so they can function and be a normal person.
This study explores the relationship between antipsychotic use and mortality in elderly patients on the impact of preventive health measures in elderly populations.
Why are psychotropic drugs prescribed in nursing homes?
Schenk:
What, so this is gonna sound like a strange question, but what is the beers list?
Meivogel:
Oh, so on the beers list it’s a psycho, there’s a whole bunch of medications on that list. It’s a list that was, created by a Dr. Peter Beers in 1991. He has since passed on, but the American Geriatric Society has now taken it over. So basically it’s a whole bunch of list of medications that’s really not recommended to be prescribed in any elderly adults. Just because when you’re older. You lose kidney function, it doesn’t absorb as well, but it’s just a list of recommendations to avoid these medications because they can cause. Not the intended effect when patients take these medications.
Findings reveal prescribing trends for dementia-related behavior management on the impact of preventive health measures in elderly populations.
Schenk:
So nothing to do with jewelry or diamond rings?
Meivogel:
No. Not at all.
Schenk:
Like whenever I hear beers or beers list, that’s what I think I’m like, oh my gosh, is it Valentine’s Day? What’s going on? Not like I’m gonna buy any jewelry for my wife anyway. She’s low key. So I’ve got lucky with that respect.
Meivogel:
Yeah.
How do psychotropic drugs increase fall risk?
Schenk:
But anyway okay let’s transition then into like how would a psychotropic drug, if it’s, if it, if there’s a certain benefit to it, if we’re modifying a certain behavior okay. That we perhaps wanna minimize or eliminate, how does that affect somebody’s risk of fall?
Meivogel:
These medications when they take them, they cause heavy sedation. And sometimes when a patient takes ’em, if they’re acting not where the not where the nursing home would want them to be at, where they would be disruptive to themselves or other patients.
Explore improper prescribing practices in Episode 107: Nursing Homes Improperly Medicate Residents.
These medications are given and they can have other intended effects. Like instead of calming ’em down, they can make ’em more agitated. That can lead to falls. The heavy sedation, sometimes it lowers your blood pressures. It can cause confusion.
Learn about strategies to reduce psychotropic drug use in long-term care on the impact of preventive health measures in elderly populations.
Schenk:
I see. So essentially we’re talking about agitation.
Maybe it may, maybe it makes a resident more prone to wander or to get up and the drowsiness or the sedation factor would ha, would affect the body’s mechanics of being able to walk around without falling.
Meivogel:
Yes.
Schenk:
And again, this episode, we’re not for the audience out there, we’re not talking about the rights and wrongs of prescribing these.
If you wanna know more about, why psychotropics are prescribed and whether or not they’re abused in that. Circumstance. Go to episode 1 0 7, where we talked with Kelly Bagby as well as episode 2 35, which was from January of 2025 with Dr. Dr. Mack was on reducing medication errors. But anyway, I digress.
So Amanda if we know that there are certain types of. Psychotropic drugs that might increase the likelihood that a resident would fall. K Kind of what can we do to mitigate that risk in and of itself? What’s what it’s almost like in a sense, almost like a catch 22.
Like we have a behavior that’s potentially a problem. We need to mitigate that behavior, but at the same time, we also have the ramification that there’s a fall. Like how do we balance these things?
Meivogel:
Yeah. It always comes down to like education and more staff. Not everybody can work with this type of patient, when they’re having these episodes.
So it takes a lot of training and patience and education to work with these patients to prevent falls, to calm ’em down without using medications or other resources or other ways that the nursing homes may. Calm the patient down. Yeah, I just, old education and staff, instead of the basic, oh.
Research highlights behavioral interventions as an alternative to chemical restraints on the impact of preventive health measures in elderly populations.
When I was as a nurse myself I would always explain to the nursing assistant that may be working with the patient, Hey, this patient’s on this medication, she may have more increased risk for fall. So sometimes it just comes down to basic communication, just like that.
Discover the physiological impact of long-term medication use in aging adults on the impact of preventive health measures in elderly populations.
Which psychotropic medications are most commonly linked to falls?
Schenk:
And what are some of the more prominent or more common psychotropic medications that have that consequence of making somebody a higher risk of fall
Meivogel:
Seroquel? That’s widely used. It’s on the beers list for multiple of reasons. But again, if your medication’s on that list, it does, it doesn’t mean that the doctor can’t prescribe it, it’s just there’s more. Things to watch out for more side effects to watch out for.
For insight into civil rights violations in long-term care, read about how mental health patients are often forced into nursing homes.
How can nursing homes mitigate the risk of falls with residents who take psychotropic drugs?
Schenk:
So would you recommend to a family that has a loved one in a nursing home that they understand the beers list or what are some things that you would tell them if you had a family in front of you and they were worried about their loved one falling due to drug to medication use in the nursing home?
Meivogel:
Yeah, definitely. I would tell them to keep a log of the behaviors. If they know that their loved one is on this medication. Keep a log to see. After they take this medication or how they behave, is it increasing? Are they really sedated? Maybe they can decrease the dose or maybe they don’t need to be on it anymore. But again, I’m not a prescriber, these are just things that I observe.
Learn how a drug error in a nursing home may lead to a personal injury claim.
What signs should families look for if a loved one is at risk from these drugs?
Schenk:
Okay, so let me make let’s unpack that a little bit. What are we observing? What’s any change in the behavior or, right?
Meivogel:
If they notice that, say mom was able to walk, or was able to walk on balance. Now all of a sudden today she’s off balance. I see. That would be a sign to let somebody know that, hey, my mom’s off balance today. Because one of the side, one of the recommendations on the beers list for Seroquel is it can cause infections also. So when a patient has infections, they exhibit others. Like off balance and fevers.
Understand your legal options when facilities use chemical restraints on nursing home residents.
Schenk:
So I guess it, like it really does come down to a balancing list. If we have a psychotropic drug as a potential intervention, we analyze whether that intervention is appropriate under the circumstances and then based on that particular intervention, we have to have other interventions.
Meivogel:
Yeah, another good intervention. I’ve worked in some nursing homes that use restorative aids. Again, it comes down to resources, education.
Learn steps families and staff can take in Minimize Medication Errors in Nursing Homes.
Schenk:
What is a restorative aide?
Meivogel:
A restorative aide could helps. When patients are in nursing homes, a lot of times once their physical therapy runs out, they’re not really getting much exercise. The aid or restorative aid is assigned to patients to go and do basic exercises. With the patient, almost like a range of motion, basic range of motion with a patient.
If a facility in Atlanta administered the wrong medication, consult an Atlanta nursing home abuse lawyer for medication errors.
Schenk:
I see. So almost like you you’re working on the residents, like physical abilities in that sense as opposed to Yeah. And a cognitive issue.
Meivogel:
And that can help decrease falls.
Schenk:
See, all right let’s transition a little bit then. So what are some of the other. Other things that you might see, other interventions that you might see in a care plan for somebody that might be at a higher risk for fall based on a psychotropic drug.
Meivogel:
So on a care plan, they may have the patient have they have one-on-ones that may be an intervention. Again, that’s gonna be staffing and, maybe they can adjust the time that they’re giving the medication. Maybe give it closer to bedtime. That’s a good intervention. Ba I’m trying to think. Besides the basics.
Before choosing a facility, it’s essential to always check nursing home ratings.
Schenk:
No, ba the basics. The basics are fine.
Meivogel:
That’s okay. Make sure they have, if they have to have a walker, make sure they have their devices that they need. Sure. And of course, the basics. Make sure they have, they’ve gone to the bathroom, that’s where a lot of the falls are at in nursing homes or bathrooms. And then also back to the basics lighting, making sure there’s nothing, nothing in the walkways.
In Episode 54: Medication Errors and Nursing Homes, we break down how medication mistakes occur.
Schenk:
I see. Very good, Amanda. I we definitely appreciate you coming on the show and sharing your knowledge with us today.
Meivogel:
Thank you so much for having me.
Schenk:
Folks, I hope that you’ve found this episode educational. If you have any ideas for topics that you would like for me to discuss, please let me know. If you have any ideas for guests that you would like for me to talk to, please let me know that as well. Please enter the contest to win the stupid mug.
Okay. Just do it. Like, why not? It’s a coffee mug. Look, you’re not paying for shipping. It’s literally just putting something into TikTok. You’re on TikTok anyway. You’re scrolling for at least an hour on TikTok a day. Just go on there, answer the question. Put your favorite boy band. Get your coffee mug.
New episodes in the Nursing Home Abuse podcast come out every single Monday. And with that folks, we’ll see you next time.
Amanda Meivogel’s Contact Information: