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Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents
Journal article   Open access   Peer reviewed

Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents

Joseph T. Hanlon, Xinhua Zhao, Jennifer G. Naples, Sherrie L. Aspinall, Subashan Perera, David A. Nace, Nicholas G. Castle, Susan L. Greenspan, Jennifer A Taylor and Carolyn T. Thorpe
Journal of the American Geriatrics Society (JAGS), v 65(6), pp 1183-1189
Jun 2017
PMID: 28152179
url
https://europepmc.org/articles/pmc5478454View
Accepted (AM)Open Access (License Unspecified) Open

Abstract

Geriatrics & Gerontology Life Sciences & Biomedicine Science & Technology Gerontology
Objectives : To examine the association between CNS medication burden and serious falls in those with a recent fall history. DesignNested-case control study; cases matched to four controls by age, gender, and date. SettingUS nursing homes. Participants : 5,556 residents age 65 with a recent fall history admitted to a nursing home between 1/1-9/30/2010 and followed until discharge, death, or December 31, 2010. Measurements : Outcome was serious falls as per Medicare Part A and B ICD/CPT codes. CNS burden, from Medicare Part D data, was calculated by dividing the daily dose of each CNS agent (i.e., specific antidepressants, antiepileptic, antipsychotic, benzodiazepine and opioid receptor agonists) received during the 6 days prior to the index (outcome) date by the minimum effective geriatric daily dose and summing the results across medications. Results : There were 367 cases and 1,468 matched controls. Those taking 3 + CNS standardized daily doses were more likely to have a serious fall than those not taking any CNS medications (Adjusted Odds Ratio 1.83; 95% confidence interval 1.35-2.48). There was no significant difference in fall risk for residents taking >0 to <3 CNS standardized daily doses compared to residents taking no CNS medications (Adjusted Odds Ratio 0.85; 95% CI 0.63-1.15). Conclusion : CNS medication burden, approximately 3 + standardized daily doses, was associated with an increased risk of serious falls in nursing home residents with recent fall. Clinicians should be vigilant for opportunities to discontinue or decrease the doses of individual CNS medications and/or consider non-pharmacological alternatives. Such interventions that reduce use of CNS medications in nursing homes could reduce fall rates but further research is needed to confirm this.

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Collaboration types
Domestic collaboration
Web of Science research areas
Geriatrics & Gerontology
Gerontology
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