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Journal article
Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents
Journal of the American Geriatrics Society (JAGS), v 65(6), pp 1183-1189
Jun 2017
PMID: 28152179
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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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Details
- Title
- Central Nervous System Medication Burden and Serious Falls in Older Nursing Home Residents
- Creators
- Joseph T. Hanlon - University of PittsburghXinhua Zhao - University of PittsburghJennifer G. Naples - University of PittsburghSherrie L. Aspinall - University of PittsburghSubashan Perera - University of PittsburghDavid A. Nace - University of PittsburghNicholas G. Castle - University of PittsburghSusan L. Greenspan - University of PittsburghJennifer A Taylor - Drexel University, Environmental and Occupational HealthCarolyn T. Thorpe - University of Pittsburgh
- Publication Details
- Journal of the American Geriatrics Society (JAGS), v 65(6), pp 1183-1189
- Publisher
- Wiley
- Number of pages
- 7
- Grant note
- R18-HS023779 / Agency for Health Research and Quality; United States Department of Health & Human Services; Agency for Healthcare Research & Quality IIR 12-379; IIR 14-297; IIR 14-306; IIR 15-115 / VA Health Services Research R01-AG050302; R01-AG05123; T32-AG021885; P30-AG02482706 / National Institutes on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) Donoghue Foundation R18HS023779 / AGENCY FOR HEALTHCARE RESEARCH AND QUALITY; United States Department of Health & Human Services; Agency for Healthcare Research & Quality R01AG050302 / NATIONAL INSTITUTE ON AGING; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Environmental and Occupational Health
- Web of Science ID
- WOS:000403894000014
- Scopus ID
- 2-s2.0-85011697944
- Other Identifier
- 991021471211704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Geriatrics & Gerontology
- Gerontology