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Journal Article

Citation

Hart LA, Marcum ZA, Gray SL, Walker RL, Crane PK, Larson EB. Pharmacotherapy 2019; ePub(ePub): ePub.

Affiliation

Division of General Internal Medicine, University of Washington, Seattle, Washington.

Copyright

(Copyright © 2019, Pharmacotherapy Publications)

DOI

10.1002/phar.2244

PMID

30861179

Abstract

OBJECTIVES: To examine the association between central nervous system (CNS)-active medication use and risk of fall-related injury in community-dwelling older adults following dementia onset. Further, to evaluate increased risk at higher doses or with greater number of CNS-active medications classes.

METHODS: Participants included community-dwelling older adults aged ≥65 years with a dementia diagnosis participating in the Adult Changes in Thought Study. From automated pharmacy data, a time-varying composite measure of CNS-active medication use was created. Central nervous system-active medication use was classified as: current (use within prior 30 days), recent (prior 31-90 days), past (prior 91-365 days), and non-use (no exposure in prior year). For current users, standardized daily doses (SDDs) were calculated for each CNS-active medication and summed SDDs across medications, and also measured number of CNS-active medication classes used. The outcome was fall-related injury based on emergency department, inpatient, and outpatient International Classification of Diseases, Ninth Revision (ICD-9) and external cause of injury (E) codes.

RESULTS: Among 793 subjects, there were 303 fall-related injuries over a mean follow-up of 3.7 years (2,907 total person-years). Relative to non-use, fall risk was significantly higher for current use (adjusted hazard ratio [HR] 1.59; 95% confidence internal [CI] 1.19-2.12), but not for past or recent use. Among current users, increased risk was seen across SDD levels; HRs (95% CI): 1.77 (1.19-2.62), 1.79 (1.25-2.56), and 1.35 (0.96-1.92) for <1 SDD, 1 to <2 SDD, and ≥2 SDD, respectively (trend test, p = 0.14). A trend was seen for increasing risk with greater number of CNS-active medication classes, however, this was not statistically significant (trend test, p = 0.084).

CONCLUSIONS: Current use of CNS-active medications was associated with fall-related injury in community-dwelling older adults followed from time of dementia onset, with increased risk even with use of low doses. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.


Language: en

Keywords

CNS-active agents; accidental falls; dementia

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