Central Nervous System Medication Burden and Risk of Recurrent Serious Falls and Hip Fractures in Veterans Affairs Nursing Home Residents

Abstract

Objectives To examine the association between central nervous system (CNS) medication dosage burden and risk of serious falls, including hip fractures, in individuals with a history of a recent fall. Design Nested case–control study. Setting Veterans Health Administration (VHA) Community Living Centers (CLCs). Participants CLC residents aged 65 and older with a history of a fall or hip fracture in the year before a CLC admission between July 1, 2005, and June 30, 2009. Each case (n = 316) was matched to four controls (n = 1264) on age, sex, and length of stay. Measurements Outcomes were serious falls identified using International Classification of Diseases, Ninth Revision (ACD‐9) or Current Procedural Terminology (CPT) E codes, diagnosis codes, or procedure codes associated with a VHA emergency department visit or hospitalization during the CLC stay. Bar code medication administration data were used to calculate CNS standardized daily doses (SDDs) for opioid and benzodiazepine receptor agonists, some antidepressants, antiepileptics, and antipsychotics received in the 6 days before the outcome date by dividing residents' actual CNS daily doses by the minimum effective geriatric daily doses and adding the results. Multivariable conditional logistic regression models were used to evaluate the association between total CNS medication dosage burden, categorized as 0, 1 to 2, and 3 or more SDDs, and the outcome of recurrent serious falls. Results More cases (44.3%) than controls (35.8%) received 3.0 or more CNS SDDs (p = .02). Risk of serious falls was greater in residents with 3.0 or more SDDs than in those with 0 (adjusted odds ratio (aOR)=1.49, 95% confidence interval (CI)=1.03–2.14). Those with 1.0 to 2.9 SDDs had a risk similar to that of those with 0 SDDs (aOR=1.03, 95%CI=0.72–1.48). Conclusion Nursing home residents with a history of a fall or hip fracture receiving 3.0 or more CNS SDDs were more likely to have a recurrent serious fall than those taking no CNS medications. Interventions targeting this vulnerable population may help reduce serious falls. J Am Geriatr Soc 67:74–80, 2019.

Incidence and Predictors of Aspirin Discontinuation in Older Adult Veteran Nursing Home Residents at End of Life

“…Individual variables representing markers of poor prognosis were constructed using MDS items including cancer diagnosis, swallowing problems, intravenous (IV) tube feeding, mechanical diet, poor appetite, recent weight loss, shortness of breath, recent changes in cognitive status, dehydration, renal failure, and pain. Having a fall in the 180 days before admission was identified using the MDS fall history item and/or meeting established claims‐based criteria for serious fall injuries . Behavioral problems were assessed using the MDS Aggressive Behavior Scale .…”

“…Having a fall in the 180 days before admission was identified using the MDS fall history item and/or meeting established claims-based criteria for serious fall injuries. [36][37][38] Behavioral problems were assessed using the MDS Aggressive Behavior Scale. 39 Dependency in activities of daily living (ADLs) was assessed using the ADL short form.…”

An updated analysis of opioids increasing the risk of fractures

“…The main reason for the increase was that patients taking opioids were prone to vertigo and falls that can lead to fractures. In addition, Aspinall's et al [6] study showed that patients receiving opioid therapy had an increased risk of falls, and the accompanying final outcomes were fractures [6]. Schwarzer et al's [8] study also suggested that when opioid use was considered, the risk of fractures increased [8].…”

“…In addition, studies have shown that opioid-induced fractures are associated with time of use [5] and are also associated with the use of opioids [6]. Opioids have been linked to the occurrence of fractures [2,3,[7][8][9][10][11], and although the use of opioids has been reported to increase the risk of fractures, the trend of using opioids continues to increase [12].…”

An updated analysis of opioids increasing the risk of fractures

“…In addition, studies have shown that opioid-induced fractures are associated with time of use [5] and are also associated with the use of opioids [6]. Opioids have been linked to the occurrence of fractures [2,3,7–11], and although the use of opioids has been reported to increase the risk of fractures, the trend of using opioids continues to increase [12].…”