259168 Frequency of falls and quality of life in elderly nursing home patients receiving phenytoin

Monday, October 29, 2012

Ahmed Soliman, MS, PhD Candidate , Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN
Ilo Leppik, MD , Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN
Angeline Carlson, PhD , Data Intelligence Consultants, Eden Prairie, MN
John Rarick, BS , Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN
Brett Kistner, BA , Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN
Angela Birnbaum, PhD , Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN
Background: Phenytoin is the most frequently prescribed anti-epileptic drug in nursing homes even though newer AEDs have a better safety profile. We sought to evaluate differences in baseline characteristics, frequency of falls and differences in quality of life of patients using phenytoin compared to other AEDs.

Methods: Residents from six nursing homes in Minneapolis/ St. Paul taking an AED, ≥60 years, and not residing in a rehabilitative care unit were included. Patients were classified as using phenytoin only or another AED (levetiracetam, lamotrigine, or gabapentin). Demographic information and co-morbidities were recorded at a baseline visit; number of falls and quality of life (EQ5D) were determined for 3 additional visits (4-6 weeks apart). Co-morbidities were used to derive a baseline Charlson score for each patient. Health state utilities were computed from EQ5D scores using US weights. Results were compared between groups using the Mann-Whitney U test. Results: There were 7 patients in the phenytoin group and 46 in the other AED group. Patients in the other AED group had higher Charlson scores (2.39 vs. 0.28, P-value<0.01) but no differences in other demographic characteristics at baseline. The phenytoin group had a higher number of falls compared to the other AED group (1.85 vs.0.73 falls, p-value<0.05). Utility scores over the follow-up visits were not significantly different. Conclusion: Exposure to an older AED can have an impact on the frequency of falls and the quality of life of nursing home patients. This has clinical and economic implications for the choice of AED therapy.

Learning Areas:
Chronic disease management and prevention
Public health or related nursing
Public health or related research

Learning Objectives:
This study aims at describing differences in the frequency of falls and quality of life between patients receiving phenytoin only as their anti-epileptic drugs and patients receiving newer anti-epileptic drugs.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD Candidate in the field of health outcomes research with a minor in biostatistics. I recieved my Master's degree with emphasis on health outcomes research as well. I have worked on the statistical analysis, interpretation and inferences drawn from this study. This study was funded by NIH/NIA R01-AG026390 from the National Institute on Aging (NIA).
Any relevant financial relationships? No

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.