Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois.
Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
J Am Geriatr Soc. 2019 Jan;67(1):74-80. doi: 10.1111/jgs.15603. Epub 2018 Oct 11.
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.
Nested case-control study.
Veterans Health Administration (VHA) Community Living Centers (CLCs).
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.
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.
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).
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.
研究中枢神经系统（CNS）药物剂量负担与近期有跌倒史的个体发生严重跌倒（包括髋部骨折）风险之间的关系。
巢式病例对照研究。
退伍军人事务部（VA）社区生活中心（CLC）。
2005 年 7 月 1 日至 2009 年 6 月 30 日期间，在 CLC 入院前一年内有跌倒或髋部骨折史且年龄在 65 岁及以上的 CLC 居民。每位病例（n=316）均与年龄、性别和住院时间匹配的 4 名对照（n=1264）相匹配。
结局是使用国际疾病分类第 9 版（ICD-9）或当前程序术语（CPT）E 代码、诊断代码或与 VHA 急诊科就诊或住院相关的程序代码识别出的严重跌倒。使用条形编码药物管理数据计算接受阿片类药物和苯二氮䓬受体激动剂、某些抗抑郁药、抗癫痫药和抗精神病药的居民在结局日期前 6 天的中枢神经系统标准化日剂量（SDD），方法是将居民的实际中枢神经系统日剂量除以最低有效老年日剂量并将结果相加。多变量条件逻辑回归模型用于评估总中枢神经系统药物剂量负担（分为 0、1-2 和 3 或更多 SDD）与复发性严重跌倒之间的关联。
与对照组（35.8%）相比，更多的病例（44.3%）接受了 3.0 个或更多的中枢神经系统 SDD（p=0.02）。与 0 SDD 相比，接受 3.0 个或更多 SDD 的居民发生严重跌倒的风险更高（调整后的优势比[aOR]=1.49，95%置信区间[CI]=1.03-2.14）。接受 1.0-2.9 SDD 的患者的风险与接受 0 SDD 的患者相似（aOR=1.03，95%CI=0.72-1.48）。
有跌倒或髋部骨折史且接受 3.0 个或更多中枢神经系统 SDD 的疗养院居民比不服用中枢神经系统药物的患者更有可能再次发生严重跌倒。针对这一脆弱人群的干预措施可能有助于减少严重跌倒。J Am Geriatr Soc 67:74-80, 2019.
