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Abstract #157696

Gary S. Sorock, PhD¹, Patricia Quigley, PhD², Michelle Rutledge, PhD², Jennifer Taylor, MPH³, Xianghua Luo, PhD⁴, Philip Foulis, MD², Michele Bellantoni, MD⁵, Susan P. Baker, MPH⁶, Ravi Varadhan, PhD⁷, and Mei-Cheng Wang, PhD⁸. (1) Geriatric Research Services, 312 Central Ave., Glyndon, MD 21071, 410-526-1098, gsorock@jhsph.edu, (2) VISN 8 Patient Safety Center, 11605 North Nebraska, Tampa, FL 33612, (3) Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, 5th Floor, Hampton House, Room 529, Baltimore, MD 21205-1996, (4) Department of Biostatistics, University of Minnesota, 420 Delaware St, SE, Minneapolis, MN 55455, (5) Johns Hopkins Bayview Care Center, 4940 Eastern Ave., Baltimore, MD 21224, (6) Center for Injury Research and Policy, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, (7) Division of Geriatrics and Gerontology, Johns Hopkins School of Medicine, 202 East Monument St, Baltimore, MD 21205, (8) Biostatistics, Johns Hopkins Bloomberg School of Public Health, Wolfe Street, E3614, Baltimore, MD 21205

Falls among nursing home residents are common and recurrent events. Epidemiologic studies have focused generally on fixed risk factors for falls (e.g. fall history, dementia) to identify high-risk individuals. Potential transient risk factors can identify high-risk time periods for falls (e.g., within days of an acute illness onset). To investigate the role of changes in medication administration before falls in nursing home residents, we conducted a case-crossover study of 419 falls in 158 residents of three nursing homes that occurred in 2002 and 2003. Incident reports were used to determine the date and time of each fall. Medication records were abstracted to identify the date of selected medication changes (new start, dose change, as needed dose, or discontinuation) during a nine-day period before the date of each fall. An inverse weighting method was used to balance the exposure effect within persons having two or more falls with those having one. The residents were on average 80.5 years old, and 67% were males. Within 1-3 days of a change in any central nervous system medication (anti-psychotic, sedative, anti-depressant, or anti-seizure) the estimated risk of falls increased 3.4 fold (95% CI 1.5, 17.3) using 7-9 days prior as a comparable control period. The within-person study design controlled for all between-person fixed confounders such as dementia, fall history, and standing balance. Because as many as 70% of all nursing home residents may be exposed to psychotropic medications, additional fall precautions might be applied specifically when changing this class of medication.

Learning Objectives:

• Describe the methodological features of the case-crossover design.
• Discuss what is meant by the short-term risk of a fall.
• Distinguish medication changes that may increase the short-term risk of a fall from those that may not.

Keywords: Frail Elderly, Nursing Homes

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.