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Delbari A, Azimi A, Najafi M, Saatchi M, Bidkhori M, Mousavi ME, Tabatabaei FS, Hooshmand E. Prevalence, Complications, and Risk Factors of Falls and Fear of Falling Among Older Adults; Based on Ardakan Cohort Study on Aging (ACSA). ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 12:e9. [PMID: 38162387 PMCID: PMC10757572 DOI: 10.22037/aaem.v12i1.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Introduction The objective of this study was to assess the prevalence of falls, fear of falling (FOF), complications arising from falls, and identify possible sociodemographic and health-related factors associated with these outcomes among older adults. Methods This cross-sectional study was based on the first wave of the Ardakan Cohort Study on Aging (ACSA), which includes participants over 50 years of age residing in Ardakan, Iran. Fall history, number of fall events, FOF, hospitalizations, and fractures in the past 12 months were assessed through a face-to-face interview. Health-related factors were recorded on a self-expressed basis. Associations were assessed using multiple logistic regression. Results Among the 4,990 participants, fall history in the past 12 months was prevalent in 19.9%, with 10.1% reporting more than two fall events. Women (p < 0.001) and older participants (p< 0.001) had a higher prevalence. In females, 28.8% reported moderate to severe FOF, while 21% experienced disruptions in their daily activities as a result of this fear. The prevalence of fractures following falls was 5.1% in males and 8.6% in females. After adjusting for confounding factors, FOF (OR: 1.59, 95% CI: 1.33-1.91, p<0.001), imbalance (OR: 2.45, 95% CI: 1.68-3.58, p<0.001), urinary incontinence (OR: 1.44, 95% CI: 1.04-1.9, p=0.025), cognitive impairment (OR: 1.21, 95% CI: 1.01-1.46, p=0.049), vertigo or dizziness (OR: 1.39, 95% CI: 1.15-1.68, p<0.001), osteoporosis (OR: 1.24, 95% CI: 1.03-1.50, p=0.023), osteoarthritis (OR: 1.33, 95% CI: 1.13-1.56, p=0.001), depression (OR: 1.30, 95% CI: 1.06-1.60, p=0.010), and Central Nervous System (CNS)-affecting diseases (OR: 1.99, 95% CI: 1.33-2.97, p=0.001) were found to have positive associations with falls. Conclusion This study showed that about one-fifth of those over 50 in Iran have experienced at least one fall within a year. Self-expressed imbalance, FOF, and urinary incontinence were the most prominent risk factors. Due to resulting in hospitalization and fractures, falls also lead to fear of falling and the associated limitation of activities.
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Affiliation(s)
- Ahmad Delbari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amirali Azimi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Morvarid Najafi
- Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saatchi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Bidkhori
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Ebrahim Mousavi
- Department of Orthotics and Prosthetics, School of Rehabilitation, University ofSocial Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh-sadat Tabatabaei
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elham Hooshmand
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Elo J, Tolppanen AM, Koponen M, Tiihonen M, Hartikainen S. Recent Hospitalization and Initiation of Antiepileptics Among Persons With Alzheimer's Disease. J Am Med Dir Assoc 2023; 24:213-219.e6. [PMID: 36403662 DOI: 10.1016/j.jamda.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/22/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Antiepileptic drugs (AEDs) are frequently prescribed for persons with Alzheimer's disease (AD), but little is known on factors associated with AED initiation in this population. We investigated whether recent hospitalization is associated with AED initiation in persons with AD. DESIGN Nested case-control study in the nationwide register-based Medication use and Alzheimer's disease (MEDALZ) cohort. PARTICIPANTS AND SETTINGS The MEDALZ cohort includes 70,718 persons diagnosed with AD during 2005-2011 in Finland. Altogether 6814 AED initiators and 6814 age-, sex-, and time since AD diagnosis-matched noninitiators were included in this study. Matching date was the date of AED initiation. METHODS AED purchases were identified from the Prescription Register and hospitalizations from the Care Register for Health Care. Recent hospitalization was defined as hospitalization ending within 2 weeks before the matching date. Association between recent hospitalization and AED initiation was assessed with conditional logistic regression. RESULTS The most frequently initiated AEDs were pregabalin (42.9%) and valproic acid (32.2%). A bigger proportion of AED initiators (36.9%) than noninitiators (5.3%) were recently hospitalized [odds ratio (OR) 10.5, 95% CI 9.22-11.9]. Dementia was the most frequent discharge diagnosis among AED initiators (29.1%) and noninitiators (27.9%). Among AED initiators, the next most frequent diagnosis was epilepsy (20.6%). Musculoskeletal diagnoses and use of analgesics including opioids was more common among gabapentinoid initiators compared with other AED initiators. CONCLUSIONS AND IMPLICATIONS Recent hospitalization was significantly related to AED initiation. Initiations of AED might have been related to common symptoms in persons with AD like neuropathic pain, epilepsy, and neuropsychiatric symptoms.
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Affiliation(s)
- Jenna Elo
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Miia Tiihonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
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Terman SW, Slinger G, Koek A, Skvarce J, Springer MV, Ziobro JM, Burke JF, Otte WM, Thijs RD, Braun KPJ. Frequency of and factors associated with antiseizure medication discontinuation discussions and decisions in patients with epilepsy: A multicenter retrospective chart review. Epilepsia Open 2023. [PMID: 36693718 DOI: 10.1002/epi4.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Guidelines suggest considering antiseizure medication (ASM) discontinuation in patients with epilepsy who become seizure-free. Little is known about how discontinuation decisions are being made in practice. We measured the frequency of, and factors associated with, discussions and decisions surrounding ASM discontinuation. METHODS We performed a multicenter retrospective cohort study at the University of Michigan (UM) and two Dutch centers: Wilhelmina Children's Hospital (WCH) and Stichting Epilepsie Instellingen Nederland (SEIN). We screened all children and adults with outpatient epilepsy visits in January 2015 and included those with at least one visit during the subsequent 2 years where they were seizure-free for at least one year. We recorded whether charts documented (1) a discussion with the patient about possible ASM discontinuation and (2) any planned attempt to discontinue at least one ASM. We conducted multilevel logistic regressions to determine factors associated with each outcome. RESULTS We included 1058 visits from 463 patients. Of all patients who were seizure-free at least one year, 248/463 (53%) had documentation of any discussion and 98/463 (21%) planned to discontinue at least one ASM. Corresponding frequencies for patients who were seizure-free at least 2 years were 184/285 (65%) and 74/285 (26%). The probability of discussing or discontinuing increased with longer duration of seizure freedom. Still, even for patients who were 10 years seizure-free, our models predicated that in only 49% of visits was a discontinuation discussion documented, and in only 16% of visits was it decided to discontinue all ASMs. Provider-to-provider variation explained 18% of variation in whether patients discontinued any ASM. SIGNIFICANCE Only approximately half of patients with prolonged seizure freedom had a documented discussion about ASM discontinuation. Discontinuation was fairly rare even among low-risk patients. Future work should further explore barriers to and facilitators of counseling and discontinuation attempts.
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Affiliation(s)
- Samuel W Terman
- University of Michigan Department of Neurology, Ann Arbor, Michigan, USA
| | - Geertruida Slinger
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Adriana Koek
- University of Michigan Department of Neurology, Ann Arbor, Michigan, USA
| | - Jeremy Skvarce
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Julie M Ziobro
- University of Michigan Department of Pediatrics, Ann Arbor, Michigan, USA
| | - James F Burke
- Ohio State University Department of Neurology, Columbus, Ohio, USA
| | - Willem M Otte
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.,Queen Square Institute of Neurology, University College London, London, UK
| | - Kees P J Braun
- Department of Child Neurology, UMC Utrecht Brain Center, Wilhelmina Children's Hospital, member of ERN EpiCare, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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Zhou S, Jia B, Kong J, Zhang X, Lei L, Tao Z, Ma L, Xiang Q, Zhou Y, Cui Y. Drug-induced fall risk in older patients: A pharmacovigilance study of FDA adverse event reporting system database. Front Pharmacol 2022; 13:1044744. [PMID: 36523498 PMCID: PMC9746618 DOI: 10.3389/fphar.2022.1044744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 09/04/2023] Open
Abstract
Objectives: As fall events and injuries have become a growing public health problem in older patients and the causes of falls are complex, there is an emerging need to identify the risk of drug-induced falls. Methods: To mine and analyze the risk signals of drug-induced falls in older patients to provide evidence for drug safety. The FDA Adverse Event Reporting System was used to collect drug-induced fall events among older patients. Disproportionality analyses of odds ratio (ROR) and proportional reported ratio were performed to detect the adverse effects signal. Results: A total of 208,849 reports (34,840 fall events and 1,898 drugs) were considered. The average age of the included patients was 76.95 ± 7.60 years, and there were more females (64.47%) than males. A total of 258 drugs with positive signals were detected to be associated with drug-induced fall incidence in older patients. The neurological drugs (104, 44.1%) with the largest number of positive detected signals mainly included antipsychotics, antidepressants, antiparkinsonian drugs, central nervous system drugs, anticonvulsants and hypnotic sedatives. Other systems mainly included the circulatory system (25, 10.6%), digestive system (15, 6.4%), and motor system (12, 5.1%). Conclusion: Many drugs were associated with a high risk of falls in older patients. The drug is one of the critical and preventable factors for fall control, and the risk level of drug-induced falls should be considered to optimize drug therapy in clinical practice.
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Affiliation(s)
- Shuang Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Boying Jia
- Department of Pharmacy, The First Hospital of Tsinghua University, Beijing, China
| | - Jiahe Kong
- China Pharmaceutical University, Basic Medicine and Clinical Pharmacy, Nanjing, Jiangsu, China
| | - Xiaolin Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing, China
| | - Lili Lei
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Zhenhui Tao
- Department of Nursing, Peking University First Hospital, Beijing, China
| | - Lingyue Ma
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- Institute of Clinical Pharmacology, Peking University, Beijing, China
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Xu XJ, Myint PK, Kioh SH, Mat S, Rajasuriar R, Kamaruzzaman SB, Tan MP. A five-year prospective evaluation of anticholinergic cognitive burden and falls in the Malaysian elders longitudinal research (MELoR) study. Arch Gerontol Geriatr 2021; 98:104535. [PMID: 34601313 DOI: 10.1016/j.archger.2021.104535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/22/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND While anticholinergic use is associated with stroke, dementia and mortality, few have evaluated its potential link with falls. To determine the relationship between anticholinergic cognitive burden (ACB) and falls over five years using the Malaysian Elders Longitudinal Research (MELoR). METHODS Community-dwelling adults aged 55 years and over were recruited through electoral roll sampling. Data obtained at baseline and follow-up (FU) at two and five years were included. Falls in the preceding 12 months were recorded. RESULTS Of the 1499 individuals (mean (SD) age= 68.9(7.5) yrs and 53.3% female) with information on baseline ACB exposure, 575(38.4%) had ACB scores of 1-2 and 117(7.8%) had ACB scores ≥3. Differences in age, ethnicity, smoking status, diabetes, hypertension, cardiovascular disease, arthritis and education existed between ACB groups. Fall occurrence differed between ACB groups at recruitment (p = 0.004) and 2-year FU (p = 0.001) but not at 5-year FU (p = 0.053). Logistic regression revealed an independent association between ACB 1-2 and falls at baseline (odds ratio, OR (95% confidence interval, CI) =1.412(1.035-1.926)) and ACB≥3 and falls at 2-yr FU (OR (95%CI) =2.098(1.032-4.263)) following adjustment for confounders. CONCLUSION Low level exposure to drugs with anticholinergic properties was associated cross-sectionally with falls, while exposure to higher levels were prospectively associated with falls at 2-year but not at 5-year FU. Future studies should determine whether avoidance of drugs with anticholinergic effects will lead to reduction in falls.
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Affiliation(s)
- Xiang Jiang Xu
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom
| | - Sheng Hui Kioh
- Ageing Clinical & Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom; Department of Chiropractic, Centre for Complementary and Alternative Medicine (CCAM), International Medical University, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Physiotherapy Program, Centre for Health Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor.
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Seibert M, Mühlbauer V, Holbrook J, Voigt-Radloff S, Brefka S, Dallmeier D, Denkinger M, Schönfeldt-Lecuona C, Klöppel S, von Arnim CAF. Efficacy and safety of pharmacotherapy for Alzheimer's disease and for behavioural and psychological symptoms of dementia in older patients with moderate and severe functional impairments: a systematic review of controlled trials. Alzheimers Res Ther 2021; 13:131. [PMID: 34271969 PMCID: PMC8285815 DOI: 10.1186/s13195-021-00867-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many patients with Alzheimer's disease (AD) are physically frail or have substantial functional impairments. There is growing evidence that such patients are at higher risk for medication-induced adverse events. Furthermore, frailty seems to be more predictive of poor clinical outcomes than chronological age alone. To our knowledge, no systematic review of clinical trials examining drug therapy of AD or behavioural and psychological symptoms of dementia (BPSD) has specifically focused on the topic of physical frailty. Our objective was to evaluate the efficacy and safety of pharmacotherapy in AD patients with frailty or significant functional impairments. METHODS We performed a systematic literature search in MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) of drug therapy of AD and BPSD in patients with significant functional impairments according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane research criteria. Significant functionally impaired patient populations were identified using the recommendations of the Medication and Quality of Life in frail older persons (MedQoL) Research Group. Screening, selection of studies, data extraction and risk of bias assessment were performed independently by two reviewers. Outcomes including functional status, cognitive function, changes in BPSD symptoms, clinical global impression and quality of life were analysed. For assessing harm, we assessed adverse events, drop-outs as a proxy for treatment tolerability and death. Results were analysed according to Cochrane standards and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Of 45,045 search results, 38,447 abstracts and 187 full texts were screened, and finally, 10 RCTs were included in the systematic review. Selected articles evaluated pharmacotherapy with acetylcholinesterase-inhibitors (AChEI), anticonvulsants, antidepressants and antipsychotics. Studies of AChEIs suggested that patients with significant functional impairments had slight but significant improvements in cognition and that AChEIs were generally well tolerated. Studies of antidepressants did not show significant improvements in depressive symptoms. Antipsychotics and anticonvulsants showed small effects on some BPSD items but also higher rates of adverse events. However, due to the very small number of identified trials, the quality of evidence for all outcomes was low to very low. Overall, the small number of eligible studies demonstrates that significantly functional impaired older patients have not been adequately taken into consideration in most clinical trials investigating drug therapy of AD and BPSD. CONCLUSION Due to lack of evidence, it is not possible to give specific recommendations for drug therapy of AD and BSPD in frail older patients or older patients with significant functional impairments. Therefore, clinical trials focussing on frail older adults are urgently required. A standardized approach to physical frailty in future clinical studies is highly desirable.
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Affiliation(s)
- M Seibert
- Department of Neurology, University Clinic Ulm, Ulm, Germany
| | - V Mühlbauer
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - J Holbrook
- Department of Neurology, University Clinic Ulm, Ulm, Germany
| | - S Voigt-Radloff
- Center for Geriatric Medicine and Gerontology, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - S Brefka
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - D Dallmeier
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - M Denkinger
- Agaplesion Bethesda Clinic, Institute for Geriatric Research, Ulm University, Ulm, Germany
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - C Schönfeldt-Lecuona
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Ulm, Germany
| | - S Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - C A F von Arnim
- Geriatric Center Ulm/Alb-Donau, Ulm, Germany.
- Division of Geriatrics, University Medical Centre, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Milosevic V, Linkens A, Winkens B, Hurkens KPGM, Wong D, van Oijen BPC, van der Kuy HM, Mestres-Gonzalvo C. Fall incidents in nursing home residents: development of a predictive clinical rule (FINDER). BMJ Open 2021; 11:e042941. [PMID: 33941626 PMCID: PMC8098923 DOI: 10.1136/bmjopen-2020-042941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To develop (part I) and validate (part II) an electronic fall risk clinical rule (CR) to identify nursing home residents (NH-residents) at risk for a fall incident. DESIGN Observational, retrospective case-control study. SETTING Nursing homes. PARTICIPANTS A total of 1668 (824 in part I, 844 in part II) NH-residents from the Netherlands were included. Data of participants from part I were excluded in part II. PRIMARY AND SECONDARY OUTCOME MEASURES Development and validation of a fall risk CR in NH-residents. Logistic regression analysis was conducted to identify the fall risk-variables in part I. With these, three CRs were developed (ie, at the day of the fall incident and 3 days and 5 days prior to the fall incident). The overall prediction quality of the CRs were assessed using the area under the receiver operating characteristics (AUROC), and a cut-off value was determined for the predicted risk ensuring a sensitivity ≥0.85. Finally, one CR was chosen and validated in part II using a new retrospective data set. RESULTS Eleven fall risk-variables were identified in part I. The AUROCs of the three CRs form part I were similar: the AUROC for models I, II and III were 0.714 (95% CI: 0.679 to 0.748), 0.715 (95% CI: 0.680 to 0.750) and 0.709 (95% CI: 0.674 to 0.744), respectively. Model III (ie, 5 days prior to the fall incident) was chosen for validation in part II. The validated AUROC of the CR, obtained in part II, was 0.603 (95% CI: 0.565 to 0.641) with a sensitivity of 83.41% (95% CI: 79.44% to 86.76%) and a specificity of 27.25% (95% CI 23.11% to 31.81%). CONCLUSION Medication data and resident characteristics alone are not sufficient enough to develop a successful CR with a high sensitivity and specificity to predict fall risk in NH-residents. TRIAL REGISTRATION NUMBER Not available.
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Affiliation(s)
- Vanja Milosevic
- Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The Netherlands
- Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - Aimee Linkens
- Internal Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Department of Hospital Pharmacy, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Bjorn Winkens
- Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Kim P G M Hurkens
- Geriatric Medicine, Department of Internal Medicine, Zuyderland Medisch Centrum, Heerlen, Limburg, The Netherlands
| | - Dennis Wong
- Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The Netherlands
| | - Brigit P C van Oijen
- Clinical Pharmacy, Pharmacology and Toxicology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen and Heerlen, Limburg, The Netherlands
| | - Hugo M van der Kuy
- Department of Hospital Pharmacy, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Carlota Mestres-Gonzalvo
- Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
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Fisher L, Fisher A, Smith PN. Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review). J Clin Med 2020; 9:E3253. [PMID: 33053671 PMCID: PMC7600664 DOI: 10.3390/jcm9103253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis (OP) and osteoporotic fractures (OFs) are common multifactorial and heterogenic disorders of increasing incidence. Helicobacter pylori (H.p.) colonizes the stomach approximately in half of the world's population, causes gastroduodenal diseases and is prevalent in numerous extra-digestive diseases known to be associated with OP/OF. The studies regarding relationship between H.p. infection (HPI) and OP/OFs are inconsistent. The current review summarizes the relevant literature on the potential role of HPI in OP, falls and OFs and highlights the reasons for controversies in the publications. In the first section, after a brief overview of HPI biological features, we analyze the studies evaluating the association of HPI and bone status. The second part includes data on the prevalence of OP/OFs in HPI-induced gastroduodenal diseases (peptic ulcer, chronic/atrophic gastritis and cancer) and the effects of acid-suppressive drugs. In the next section, we discuss the possible contribution of HPI-associated extra-digestive diseases and medications to OP/OF, focusing on conditions affecting both bone homeostasis and predisposing to falls. In the last section, we describe clinical implications of accumulated data on HPI as a co-factor of OP/OF and present a feasible five-step algorithm for OP/OF risk assessment and management in regard to HPI, emphasizing the importance of an integrative (but differentiated) holistic approach. Increased awareness about the consequences of HPI linked to OP/OF can aid early detection and management. Further research on the HPI-OP/OF relationship is needed to close current knowledge gaps and improve clinical management of both OP/OF and HPI-related disorders.
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Affiliation(s)
- Leon Fisher
- Department of Gastroenterology, Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
| | - Paul N Smith
- Department of Orthopedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia;
- Australian National University Medical School, Canberra 2605, Australia
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Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review. J Clin Med 2020; 9:jcm9082329. [PMID: 32707829 PMCID: PMC7463822 DOI: 10.3390/jcm9082329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 02/01/2023] Open
Abstract
Osteoporosis leads to increased risk of falls, and thus an increase in fractures, highlighting here hip fractures, that result in high mortality, functional disability, and high medical expenditure. The aim is to summarise the available evidence on effective non-pharmacological interventions to prevent the triad osteoporosis/falls risk/hip fracture. A scoping review was conducted consulting the Scientific Electronic Library Online (Scielo), National Institute for Health and Care Excellence (NICE), Cumulative Index to Nursing & Allied Health Literature (CINAHL) y PubMed.databases. Inclusion criteria were articles published between 2013 and 2019, in Spanish or English. In addition, publications on a population over 65 years of age covering non-pharmacological interventions aimed at hip fracture prevention for both institutionalised patients in long-stay health centres or hospitals, and patients cared for at home, both dependent and non-dependent, were included. Sixty-six articles were selected and 13 non-pharmacological interventions were identified according to the Nursing Interventions Classification taxonomy, aimed at preventing osteoporosis, falls, and hip fracture. The figures regarding the affected population according to the studies are alarming, reflecting the importance of preventing the triad osteoporosis, falls risk, and hip fracture among the population over 65 years of age. The most effective interventions were focused on increasing Bone Mineral Density through diet, exercise, and falls prevention. As a conclusion, primary prevention should be applied to the entire adult population, with special emphasis on people with osteoporosis.
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Zhao D, Shridharmurthy D, Alcusky MJ, Yuan Y, Nunes AP, Hume AL, Baek J, Lapane KL. The Prevalence and Factors Associated with Antiepileptic Drug Use in US Nursing Home Residents. Drugs Aging 2020; 37:137-145. [PMID: 31845208 DOI: 10.1007/s40266-019-00732-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antiepileptic drugs (AEDs) are commonly used by nursing home residents, both on- and off-label. The landscape of AED use has changed over the past two decades; however, despite this, contemporaneous research on AED use in US nursing home residents is scant. OBJECTIVE The aim of this study was to estimate the prevalence of AED use, describe prescribing patterns, identify factors associated with AED use, and assess whether these factors differ among AEDs with expanded indications in older adults (i.e. gabapentin, pregabalin, topiramate, and lamotrigine). METHODS We conducted a cross-sectional study among 549,240 long-stay older residents who enrolled in fee-for-service Medicare and lived in 15,111 US nursing homes on 1 September 2016. Demographics and conditions associated with AED indications, epilepsy comorbidities, and safety data came from the Minimum Data Set Version 3.0 (MDS 3.0). Medicare Part D claims were used to identify AED use. Robust Poisson models and multinomial logistic models for clustered data estimated adjusted prevalence ratios (aPR), adjusted odds ratios (aOR), and 95% confidence intervals (CIs). RESULTS Overall, 24.0% used AEDs (gabapentin [13.3%], levetiracetam [4.7%], phenytoin [1.9%], pregabalin [1.8%], and lamotrigine [1.2%]). AED use was associated with epilepsy (aPR 3.73, 95% CI 3.69-3.77), bipolar disorder (aPR 1.20, 95% CI 1.18-1.22), pain (aPRmoderate/severe vs. no pain 1.42, 95% CI 1.40-1.44), diabetes (aPR 1.27, 95% CI 1.26-1.28), anxiety (aPR 1.12, 95% CI 1.11-1.13), depression (aPR 1.17, 95% CI 1.15-1.18), or stroke (aPR 1.08, 95% CI 1.06-1.09). Residents with advancing age (aPR85+ vs. 65-74 years 0.73, 95% CI 0.73-0.74), Alzheimer's disease/dementia (aPR 0.87, 95% CI 0.86-0.88), or cognitive impairment (aPRsevere vs. no impairment 0.62, 95% CI 0.61-0.63) had decreased AED use. Gabapentinoid use was highly associated with pain (aORmoderate/severe vs. no pain 2.07, 95% CI 2.01-2.12) and diabetes (aOR 1.79, 95% CI 1.76-1.82), but not with an epilepsy indication. CONCLUSIONS AED use was common in nursing homes, with gabapentin most commonly used (presumably for pain). That multiple comorbidities were associated with AED use underscores the need for future studies to investigate the safety and effectiveness of AED use in nursing home residents.
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Affiliation(s)
- Danni Zhao
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Divya Shridharmurthy
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Matthew J Alcusky
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Anthony P Nunes
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Anne L Hume
- Department of Family Medicine, Alpert Medical School, Brown University, Memorial Hospital of Rhode Island, Providence, RI, 02903, USA.,Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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Lavikainen P, Taipale H, Tanskanen A, Koponen M, Tiihonen J, Hartikainen S, Tolppanen AM. Antiepileptic Drugs and Accumulation of Hospital Days Among Persons With Alzheimer's Disease. J Am Med Dir Assoc 2019; 20:751-758. [PMID: 30630728 DOI: 10.1016/j.jamda.2018.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the accumulation of hospital days between initiators and noninitiators of antiepileptic drugs (AEDs) among persons with Alzheimer's disease (AD). DESIGN Exposure-matched cohort study. SETTING AND PARTICIPANTS Persons newly diagnosed with AD in 2005-2011 (n = 70,718) and initiating AED use identified from Finnish health care registers. For each AED initiator, 1 noninitiator matched on age, sex, and time since AD diagnosis was selected. Persons with epilepsy were excluded from the study. METHODS Association between AED initiation or use of individual AEDs and accumulation of hospital days during a 2-year follow-up was assessed using negative binomial model. RESULTS AED initiators (n = 4432) were hospitalized on average for 43.7 (SD: 88.3) days and matched noninitiators for 32.2 (SD: 71.3) days during the 2-year follow-up. Altogether, 27.3% of the AED initiators and 35.6% of the noninitiators had no hospital days during the study period. Number of accumulated hospital days during the follow-up was 31% higher [adjusted incidence rate ratio (aIRR): 1.31, 95% confidence interval (CI): 1.19-1.43] among AED initiators than the noninitiators. Hospital days due to diseases of the nervous system excluding dementia (aIRR: 2.72, 95% CI: 1.72-4.31), musculoskeletal system (aIRR: 2.49, 95% CI: 1.73-3.58), respiratory system (aIRR: 1.89, 95% CI: 1.47-2.43), and mental and behavioral disorders excluding dementia (aIRR: 1.96, 95% CI: 1.02-3.79) were more common among the AED initiators than noninitiators. Among pregabalin (aIRR: 0.65, 95% CI: 0.56-0.77), gabapentin (aIRR: 0.66, 95% CI: 0.49-0.88), and clonazepam (aIRR: 0.73, 95% CI: 0.55-0.96) initiators, the number of accumulated hospital days was 27% to 35% lower than the days accumulated among the initiators of valproic acid. CONCLUSIONS AND IMPLICATIONS AED initiators had more hospital days than noninitiators. Pregabalin and gabapentin were associated with a lower number of hospital days than valproic acid. Further research is needed on the reasons for these findings.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Heidi Taipale
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
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