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Hanlon JT, Schmader KE. Use of new STOPP/START criteria in the care of older adults. J Am Geriatr Soc 2024; 72:318-320. [PMID: 37795884 DOI: 10.1111/jgs.18613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023]
Abstract
This article comments on the article by Rochon et al. in this issue.
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Affiliation(s)
- Joseph T Hanlon
- Division of Geriatrics, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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Santiago Martinez P, Lord SR, Close JCT, Taylor ME. Associations between psychotropic and anti-dementia medication use and falls in community-dwelling older adults with cognitive impairment. Arch Gerontol Geriatr 2023; 114:105105. [PMID: 37364485 DOI: 10.1016/j.archger.2023.105105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Evidence for effective fall prevention strategies is limited for people with cognitive impairment. Understanding what factors contribute to fall risk identifies potential intervention strategies. We aimed to determine if psychotropic and anti-dementia medication use are associated with falls in community-dwelling older people with mild-moderate cognitive impairment and dementia. DESIGN Secondary analysis of an RCT (i-FOCIS). PARTICIPANTS AND SETTING 309 community-dwelling people with mild to moderate cognitive impairment or dementia from Sydney, Australia. METHODS Demographic information, medical history, and medication use were collected at baseline and participants were followed up for 1-year for falls using monthly calendars and ancillary telephone falls. RESULTS Psychotropic medication use was associated with an increased rate of falls (IRR 1.41, 95%CI 1.03, 1.93) and slower gait speed, poor balance and reduced lower limb function when adjusting for age, sex, education and cognition, as well as RCT group allocation when examining prospective falls. Antidepressants use increased the rate of falls in a similarly adjusted model (IRR 1.54, 95%CI 1.10, 2.15), but when additionally adjusting for depressive symptoms, antidepressant use was no longer significantly associated with falls while depressive symptoms was. Anti-dementia medication use was not associated with rate of falls. CONCLUSIONS Psychotropic medication use increases fall risk, and anti-dementia medication does not reduce fall risk in older adults with cognitive impairment. Effective management of depressive symptoms, potentially with non-pharmacological approaches, is needed to prevent falls in this population. Research is also required to ascertain the risks/benefits of withdrawing psychotropic medications, particularly in relation to depressive symptoms.
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Affiliation(s)
| | - Stephen R Lord
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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Blank LJ, Agarwal P, Kwon CS, Jetté N. Association of first anti-seizure medication choice with injuries in older adults with newly diagnosed epilepsy. Seizure 2023; 109:20-25. [PMID: 37178662 PMCID: PMC10686518 DOI: 10.1016/j.seizure.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Epilepsy incidence increases exponentially in older adults, who are also at higher risk of adverse drug effects. Anti-seizure medications (ASM) may be associated with sedation and injuries, but discontinuation can result in seizures. We sought to determine whether there was an association between prescribing non-guideline concordant ASM and subsequent injury as this could inform care models. METHODS Retrospective cohort study of adults 50 years or older with newly-diagnosed epilepsy in 2015-16, sampled from the MarketScan Databases. The outcome of interest was injury within 1-year of ASM prescription (e.g., burns, falls) and the exposure of interest was ASM category (recommended vs. not recommended by clinical guidelines). Descriptive statistics characterized covariates and a multivariable Cox-regression model was built to examine the association between ASM category and subsequent injury. RESULTS 5,931 people with newly diagnosed epilepsy were prescribed an ASM within 1-year. The three most common ASMs were: levetiracetam (62.86%), gabapentin (11.73%), and phenytoin (4.45%). Multivariable Cox-regression found that medication category was not associated with injury; however, older age (adjusted hazard ratio (AHR) 1.01/year), history of prior injury (AHR 1.77), traumatic brain injury (AHR 1.55) and ASM polypharmacy (AHR 1.32) were associated with increased hazard of injury. CONCLUSIONS Most older adults appear to be getting appropriate first prescriptions for epilepsy. However, a substantial proportion still receives medication that guidelines suggest avoiding. In addition, we show that ASM polypharmacy is associated with an increased hazard of injury within 1- year. Efforts to improve prescribing in older adults with epilepsy should consider how to reduce. both polypharmacy and exposure to medications that guidelines recommend avoiding.
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Affiliation(s)
- Leah J Blank
- Department of Neurology, Division of Health Outcomes & Knowledge Translation Research, Icahn school of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY, United States; Department of Population Health and Policy, Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, United States.
| | - Parul Agarwal
- Department of Neurology, Division of Health Outcomes & Knowledge Translation Research, Icahn school of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY, United States; Department of Population Health and Policy, Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, United States
| | - Churl-Su Kwon
- Departments of Neurology, Epidemiology, Neurosurgery and the Gertrude H. Sergievsky Center, Columbia University, 622 West 168th Street, New York, NY PH19-106, United States
| | - Nathalie Jetté
- Department of Neurology, Division of Health Outcomes & Knowledge Translation Research, Icahn school of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1137, New York, NY, United States; Department of Population Health and Policy, Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, United States
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4
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Yamada Y, Yokogawa N, Kato S, Sasagawa T, Tsuchiya H, Nakashima H, Segi N, Ito S, Funayama T, Eto F, Yamaji A, Yamane J, Nori S, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Kuroda A, Inoue G, Kakutani K, Kakiuchi Y, Kiyasu K, Tominaga H, Tokumoto H, Iizuka Y, Takasawa E, Akeda K, Takegami N, Funao H, Oshima Y, Kaito T, Sakai D, Yoshii T, Ohba T, Otsuki B, Seki S, Miyazaki M, Ishihara M, Okada S, Imagama S, Watanabe K. Effects of Dementia on Outcomes after Cervical Spine Injuries in Elderly Patients: Evaluation of 1512 Cases in a Nationwide Multicenter Study in Japan. J Clin Med 2023; 12:jcm12051867. [PMID: 36902654 PMCID: PMC10003092 DOI: 10.3390/jcm12051867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to retrospectively investigate the demographic characteristics and short-term outcomes of traumatic cervical spine injuries in patients with dementia. We enrolled 1512 patients aged ≥ 65 years with traumatic cervical injuries registered in a multicenter study database. Patients were divided into two groups according to the presence of dementia, and 95 patients (6.3%) had dementia. Univariate analysis revealed that the dementia group comprised patients who were older and predominantly female and had lower body mass index, higher modified 5-item frailty index (mFI-5), lower pre-injury activities of daily living (ADLs), and a larger number of comorbidities than patients without dementia. Furthermore, 61 patient pairs were selected through propensity score matching with adjustments for age, sex, pre-injury ADLs, American Spinal Injury Association Impairment Scale score at the time of injury, and the administration of surgical treatment. In the univariate analysis of the matched groups, patients with dementia had significantly lower ADLs at 6 months and a higher incidence of dysphagia up to 6 months than patients without dementia. Kaplan-Meier analysis revealed that patients with dementia had a higher mortality than those without dementia until the last follow-up. Dementia was associated with poor ADLs and higher mortality rates after traumatic cervical spine injuries in elderly patients.
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Affiliation(s)
- Yohei Yamada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Satoshi Kato
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
- Correspondence: ; Tel.: +81-76-265-2374
| | - Takeshi Sasagawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
- Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa 920-8641, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Ibaraki 306-0433, Japan
| | - Junichi Yamane
- Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo 208-0011, Japan
| | - Satoshi Nori
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Fukui 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
- Department of Orthopedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopedic Surgery, Sapporo Medical University, Sapporo 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopedic Surgery, Shinshu University School of Medicine, Nagano 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan
- Department of Orthopedics, Saiseikai Shiga Hospital, Shiga 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Nobuyuki Suzuki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Kenji Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo 101-8393, Japan
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama 701-0192, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Akiyoshi Kuroda
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1, Kanagawa 252-0374, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1, Kanagawa 252-0374, Japan
| | - Kenichiro Kakutani
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yuji Kakiuchi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Katsuhito Kiyasu
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan
| | - Hiroyuki Tominaga
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
| | - Yoichi Iizuka
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi 371-8511, Japan
| | - Koji Akeda
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Haruki Funao
- Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Chiba 286-0124, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare Narita Hospital, Chiba 286-0124, Japan
- Department of Orthopedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa 259-1193, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima 113-8519, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Masashi Miyazaki
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Oita 879-5593, Japan
| | - Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University Hospital, Osaka 573-1191, Japan
| | - Seiji Okada
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Tokyo 160-8582, Japan
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Zhou Y, Berridge C, Hooyman NR, Sadak T, Mroz TM, Phelan EA. Development of a behavioural framework for dementia care partners' fall risk management. BMC Geriatr 2022; 22:975. [PMID: 36528769 PMCID: PMC9758825 DOI: 10.1186/s12877-022-03620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although older adults living with dementia (OLWD) are at high risk for falls, few strategies that effectively reduce falls among OLWD have been identified. Dementia care partners (hereinafter referred to as "care partners") may have a critical role in fall risk management (FRM). However, little is known about the ways care partners behave that may be relevant to FRM and how to effectively engage them in FRM. METHODS Semi-structured, in-depth interviews were conducted with 14 primary care partners (age: 48-87; 79% women; 50% spouses/partners; 64% completed college; 21% people of colour) of community-dwelling OLWD to examine their FRM behaviours, and their observations of behaviours adopted by other care partners who were secondary in the caring role. RESULTS The analysis of interview data suggested a novel behavioural framework that consisted of eight domains of FRM behaviours adopted across four stages. The domains of FRM behaviours were 1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotion support, 4. safety supervision, 5. modification of the physical environment, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment. Four stages of FRM included 1. supporting before dementia onset, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls. FRM behaviours varied by the care partners' caring responsibilities. Primary care partners engaged in behaviours from all eight behavioural domains; they often provided functional mobility assistance, safety supervision, and modification of the physical environment for managing fall risk. They also adopted behaviours of assessing and addressing health conditions, health promotion support, and receiving, seeking and coordinating care without realizing their relevance to FRM. Secondary care partners were reported to assist in health promotion support, safety supervision, modification of the physical environment, and receiving, seeking, and coordinating care. CONCLUSIONS The multi-domain and multi-stage framework derived from this study can inform the development of tools and interventions to effectively engage care partners in managing fall risk for community-dwelling OLWD.
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Affiliation(s)
- Yuanjin Zhou
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
| | - Clara Berridge
- grid.34477.330000000122986657School of Social Work, University of Washington, Seattle, USA
| | - Nancy R. Hooyman
- grid.34477.330000000122986657School of Social Work, University of Washington, Seattle, USA
| | - Tatiana Sadak
- grid.34477.330000000122986657School of Nursing, University of Washington, Seattle, USA
| | - Tracy M. Mroz
- grid.34477.330000000122986657Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - Elizabeth A. Phelan
- grid.34477.330000000122986657School of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, USA
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Chantanachai T, Taylor ME, Lord SR, Menant J, Delbaere K, Sachdev PS, Kochan NA, Brodaty H, Sturnieks DL. Risk factors for falls in community-dwelling older people with mild cognitive impairment: a prospective one-year study. PeerJ 2022; 10:e13484. [PMID: 35663527 PMCID: PMC9161814 DOI: 10.7717/peerj.13484] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/03/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Mild cognitive impairment (MCI) is considered an intermediate stage between normal cognitive function and dementia. Fall risk is increased in this group, but there is limited literature exploring specific fall risk factors that may be addressed in fall prevention strategies. The aim of this study was to examine risk factors for falls in older people with MCI, focusing on cognitive, psychological and physical factors. Methods Participants (n = 266, 45% women) were community-dwelling older people aged 70-90 years who met the criteria for MCI. Cognitive, psychological, sensorimotor and physical assessments, physical activity levels, medication use, general health and disability were ascertained at baseline. Falls were monitored prospectively for 12 months. Results During follow-up, 106 (40%) participants reported one or more falls. Poorer visual contrast sensitivity, increased postural sway, lower levels of weekly walking activity, higher levels of depressive symptoms and psychotropic medication use were significantly associated with faller status (≥1 falls) in univariable analyses. Of these factors, poor visual contrast sensitivity, increased postural sway and psychotropic medication use were found to be significant independent predictors of falls in multivariable analysis while controlling for age and sex. No measures of cognitive function were associated with falls. Conclusions Poor visual contrast sensitivity, impaired balance and psychotropic medication use predicted falls in community-dwelling people with MCI. These risk factors may be amenable to intervention, so these factors could be carefully considered in fall prevention programs for this population.
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Affiliation(s)
- Thanwarat Chantanachai
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E. Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S. Sachdev
- Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia,Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Nicole A. Kochan
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Faculty of Medicine and Health, University of New South Wales, Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Sydney, New South Wales, Australia
| | - Daina L. Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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7
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Hart LA, Walker R, Phelan EA, Marcum ZA, Schwartz NR, Crane PK, Larson EB, Gray SL. Change in central nervous system-active medication use following fall-related injury in older adults. J Am Geriatr Soc 2022; 70:168-177. [PMID: 34668191 PMCID: PMC8742750 DOI: 10.1111/jgs.17508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Central nervous system (CNS)-active medication use is an important modifiable risk factor for falls in older adults. A fall-related injury should prompt providers to evaluate and reduce CNS-active medications to prevent recurrent falls. We evaluated change in CNS-active medications up to 12 months following a fall-related injury in community-dwelling older adults compared with a matched cohort without fall-related injury. METHODS Participants were from the Adult Changes in Thought study conducted at Kaiser Permanente Washington. Fall-related injury codes between 1994 and 2014 defined index encounters in participants with no evidence of such injuries in the preceding year. We matched each fall-related injury index encounter with up to five randomly selected clinical encounters from participants without injury. Using automated pharmacy data, we estimated the average change in CNS-active medication use at 3, 6, and 12 months post-index according to the presence or absence of CNS-active medication use before index. RESULTS One thousand five hundred sixteen participants with fall-related injury index encounters (449 CNS-active users, 1067 nonusers) were matched to 7014 index encounters from people without fall-related injuries (1751 users, 5236 nonusers). Among CNS-active users at the index encounter, those with fall-related injury had an average decrease in standard daily doses (SDDs) at 12 months (-0.43; 95% CI: -0.63 to -0.23), and those without injury had a greater (p = 0.047) average decrease (-0.66; 95% CI: -0.78 to -0.55). Among nonusers at index, those with fall-related injury had a smaller increase than those without injury (+0.17, 95% CI: +0.13 to +0.21, vs. +0.24, 95% CI: +0.20 to +0.28, p = 0.005). CONCLUSIONS The differences in CNS-active medication use change over 12 months between those with and without fall-related injury were small and unlikely to be clinically significant. These results suggest that fall risk-increasing drug use is not reduced following a fall-related injury, thus opportunities exist to reduce CNS-active medications, a potentially modifiable risk factor for falls.
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Affiliation(s)
- Laura A. Hart
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA (work completed while a post-doctoral fellow at School of Pharmacy, University of Washington, Seattle, WA)
| | - Rod Walker
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA
| | - Elizabeth A. Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, and Department of Health Services, School of Public Health, University of Washington, Seattle, WA
| | - Zachary A. Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Naomi R.M. Schwartz
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
| | - Paul K. Crane
- Department of Medicine, Division of General Internal Medicine, School of Medicine; University of Washington, Seattle, WA
| | - Eric B. Larson
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA;,Department of Medicine, Division of General Internal Medicine, School of Medicine; University of Washington, Seattle, WA
| | - Shelly L. Gray
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA
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8
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Gunnarsdottir Ms Rn GH, Sigurdardóttir Phd Rn AK, Ólafsson Ma K, Kristofersson Phd Rn Pmknp-Bc GK. Psychotropic Use among Older Adults Living at Home: Use of the Anatomical Therapeutic Chemical (ATC) Drug Classification System and Beers Criteria ®. Issues Ment Health Nurs 2021; 42:1138-1146. [PMID: 34197268 DOI: 10.1080/01612840.2021.1936709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The study examined medication use among older adults living at home and connection between background characteristics, urban/rural residency, and medication use according to Anatomical Therapeutic Chemical (ATC) drug classification system and Beers Criteria®. Population-based cross-sectional study, participants (N = 175) were randomly selected from the Icelandic national registry, randomized by age, gender, and residence. On average, participants took 2.9 medications: 20% used psychotropics and 15% used psychotropics in ATC groups N05/N06A, which are deemed inappropriate for this age group according to Beers Criteria. Beers Criteria are useful for recognizing possible inappropriate medications for older adults and can be utilized by mental health nurses to assess the appropriateness of geriatric pharmaceutical treatments.
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Affiliation(s)
- G H Gunnarsdottir Ms Rn
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Nursing Homes, Vestursida, Akureyri, Iceland
| | - A K Sigurdardóttir Phd Rn
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Hospital, Iceland Eyrarlandsvegi, Akureyri
| | - K Ólafsson Ma
- School of Humanities and Social Sciences, University of Akureyri, Akureyri Iceland
| | - G K Kristofersson Phd Rn Pmknp-Bc
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Outpatient Psychiatric Ward, Akureyri Hospital, Eyralandsvegi, Akureyri Iceland
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9
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Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis. Ageing Res Rev 2021; 71:101452. [PMID: 34450352 DOI: 10.1016/j.arr.2021.101452] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 08/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community. RESULTS A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high. CONCLUSIONS In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
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10
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Yoshikawa A, Smith ML, Ory MG. Differential risk of falls associated with pain medication among community-dwelling older adults by cognitive status. Age Ageing 2021; 50:1578-1585. [PMID: 33765121 DOI: 10.1093/ageing/afab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Persons living with dementia have an elevated risk of falling and chronic pain. This study investigates the relationship of pain medication use with falls among community-dwelling adults based on their cognitive status. METHODS We analysed a nationally representative sample of community-dwelling Medicare beneficiaries (n = 7,491) who completed cognitive assessments used for dementia classification in the 2015 US National Health and Aging Trends Study. We performed survey-weighted logistic regression to investigate differential associations between pain medication use and a recent fall by cognitive status: no dementia, possible dementia and probable dementia, controlling for sociodemographic and health characteristics. RESULTS About 16.5% of the analytic sample was classified as possible dementia (8.3%) and probable dementia (8.2%). Pain medication use was associated with a recent fall among those with probable dementia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.14, 3.03], controlling for sociodemographic and health characteristics. Taking medication for pain 2 days a week or more (OR = 2.14, 95% CI: 1.20, 3.81) was associated with falls among those with probable dementia. Bothersome pain and worry about falling down were also associated with falls among participants with no dementia and possible dementia, respectively. CONCLUSION Differential risk factors for falls by cognitive status imply the need for tailored pain management and fall prevention strategies. The provision of fall prevention programmes stressing balance training and medication use is important regardless of cognitive status in community-dwelling older adults. Future research should explore other modifiable factors associated with the risk of falls among community-dwelling adults.
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Affiliation(s)
- Aya Yoshikawa
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G Ory
- Center for Population Health and Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
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11
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Shaver AL, Clark CM, Hejna M, Feuerstein S, Wahler RG, Jacobs DM. Trends in fall-related mortality and fall risk increasing drugs among older individuals in the United States,1999-2017. Pharmacoepidemiol Drug Saf 2021; 30:1049-1056. [PMID: 33534172 DOI: 10.1002/pds.5201] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have demonstrated increasing mortality due to falls among older adults. The objective of this study was to determine whether there was an increase in fall risk increasing drug prescribing and if this is concurrent with an increase in fall-related mortality in persons 65 years and older in the United States. METHODS The study is a serial cross-sectional analysis utilizing data from both the National Vital Statistics System (NVSS) and the medical expenditure panel survey (MEPS) for years 1999-2017. Adults aged 65 years and older were evaluated for death due to falls from the NVSS and for prescription fills of fall risk increasing drugs per the Stopping Elderly Accidents, Deaths, and Injuries-Rx (STEADI-Rx) fall checklist from the MEPS. RESULTS The analysis included 374 972 fall-related mortalities and 7 858 177 122 fills of fall risk increasing drugs. 563 037 964 persons age 65 and older received at least one fall risk increasing drug. Age-adjusted mortality due to falls increased from 29.40 per 100 000 in 1999 to 63.27 per 100 000 in 2017. The percent of persons who received at least one prescription for a fall risk increasing drug increased from 57% in 1999 to 94% in 2017 (p for trend <.0001). CONCLUSIONS AND RELEVANCE Both use of fall risk increasing drugs and mortality due to falls are on the rise. Fall risk increasing drugs may partially explain the increase in mortality due to falls; this cannot be firmly concluded from the current study. Future research examining the potential relationship between fall risk increasing drugs and fall-related mortality utilizing nationally representative person-level data are needed.
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Affiliation(s)
- Amy L Shaver
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, New York, USA
| | - Collin M Clark
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Mary Hejna
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Steven Feuerstein
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - Robert G Wahler
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
| | - David M Jacobs
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
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12
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Casey CM, Caulley J, Phelan EA. The Intersection of Falls and Dementia in Primary Care: Evaluation and Management Considerations. Med Clin North Am 2020; 104:791-806. [PMID: 32773046 DOI: 10.1016/j.mcna.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A large body of research has addressed the assessment and management of fall risk among community-dwelling older adults. Persons with dementia are at higher risk for falls and fall-related injuries, yet less is known about effective strategies for reducing falls and injuries among those with dementia. Falls and dementia are regularly considered to be discrete conditions and are often managed separately. Increasing evidence shows that these conditions frequently co-occur, and one may precede the other. This article explores the relationship between falls and dementia, including the importance of rehabilitation strategies for reducing fall risk in these individuals.
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Affiliation(s)
- Colleen M Casey
- Senior Health Program, Providence Health & Services, 4400 NE Halsey, Fifth Floor, Portland, OR 97213, USA.
| | - Jamie Caulley
- Senior Health Program, Providence Health & Services, 4400 NE Halsey, Fifth Floor, Portland, OR 97213, USA
| | - Elizabeth A Phelan
- Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, WA 98104-2499, USA
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13
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Association of a Novel Medication Risk Score with Adverse Drug Events and Other Pertinent Outcomes Among Participants of the Programs of All-Inclusive Care for the Elderly. PHARMACY 2020; 8:pharmacy8020087. [PMID: 32443719 PMCID: PMC7356194 DOI: 10.3390/pharmacy8020087] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Preventable adverse drug events (ADEs) represent a significant public health challenge for the older adult population, since they are associated with higher medical expenditures and more hospitalizations and emergency department (ED) visits. This study examines whether a novel medication risk prediction tool, the MedWise Risk Score™ (MRS), is associated with ADEs and other pertinent outcomes in participants of the Programs of All-Inclusive Care for the Elderly (PACE). Unlike other risk predictors, this tool produces actionable information that pharmacists can easily use to reduce ADE risk. This was a retrospective cross-sectional study that analyzed administrative medical claims data of 1965 PACE participants in 2018. To detect ADEs, we identified all claims that had ADE-related International Classification of Diseases and Health Related Problems, 10th revision (ICD-10) codes. Using logistic and linear regression models, we examined the association between the MRS and a variety of outcomes, including the number of PACE participants with an ADE, total medical expenditures, ED visits, hospitalizations, and hospital length of stay. We found significant associations for every outcome. Specifically, every point increase in the MRS corresponded to an 8.6% increase in the odds of having one or more ADEs per year (OR = 1.086, 95% CI: 1.060, 1.113), $1037 USD in additional annual medical spending (adjusted R2 of 0.739; p < 0.001), 3.2 additional ED visits per 100 participants per year (adjusted R2 of 0.568; p < 0.001), and 2.1 additional hospitalizations per 100 participants per year (adjusted R2 of 0.804; p < 0.001). Therefore, the MRS can risk stratify PACE participants and predict a host of important and relevant outcomes pertaining to medication-related morbidity.
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