Falls in nursing home residents receiving pharmacotherapy for anemia

Abstract

PurposeFalls are common among nursing home residents and have potentially severe consequences, including fracture and other trauma. Recent evidence suggests anemia may be independently related to these falls. This study explores the relationship between the use of anemia-related pharmacotherapies and falls among nursing home residents.MethodsForty nursing homes in the United States provided data for analysis. All incidents of falls over the 6-month post-index follow-up period were used to identify the outcomes of falls (≥1 fall) and recurrent falls (>1 fall). Logistic regression was used to analyze the relationship between falls and recurrent falls with each of the anemia pharmacotherapies after adjusting for potential confounders.ResultsA total of 632 residents were eligible for analysis. More than half (57%) of residents were identified as anemic (hemoglobin < 12 g/dL females, or <13 g/dL males). Of anemic residents, 50% had been treated with one or more therapies (14% used vitamin B12, 10% folic acid, 38% iron, 0.3% darbepoetin alfa [DARB], and 1.3% epoetin alfa [EPO]). Rates of falls/ recurrent falls were 33%/18% for those receiving vitamin B12, 40%/16% for folic acid, 27%/14% for iron, 38%/8% for DARB, 18%/2% for EPO, and 22%/11% for those receiving no therapy. In the adjusted models, use of EPO or DARB was associated with significantly lower odds of recurrent falls (odds ratio = 0.06; P = 0.001). Other significant covariates included psychoactive medication use, age 75–84 years, age 85+ years, worsened balance score, and chronic kidney disease (P < 0.05 for all).ConclusionOnly half of the anemic residents were found to be using anemia therapy (vitamin B12, folic acid, or iron). There is little evidence to support an association between the use of vitamin B12, folic acid, or iron in reducing the rates of falls and recurrent falls in nursing homes. Reduced odds of recurrent falls were observed for DARB or EPO users.

Hematopoiesis, Inflammation and Aging—The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals

“…Patients with anemia below 11 g/100 mL also have significantly decreased scores for activities of daily life and quality of life [130]. Second, even though at least one study has shown no associations between anemia and decreases for community-living elderly individuals [131], such an association has been observed for nursing home residents [132,133]. Third, frailty has been defined as a medical syndrome characterized by decreased physiological reserve and increased vulnerability, and frailty seems to be a predictor for nursing home placement of elderly community-dwelling individuals [134].…”

Anemia in the very aged person: how are treatment options discussed and when is red blood cell component transfusion proposed?

“…(The present paper will not address the case of hemoglobinopathy, which is specific). Anemia in the aged increases frailty, impacts cardiovascular and coronary circulation, dampens cognitive potential, and favors falls and fractures; anemia increases mortality, hospitalization, difficulty of mobility, difficulty with daily life, and fatigue [10][11][12][13][14][15].…”