Falls among residents in UK care homes are commonplace. A new study examined whether multiple medications and drugs that act on the brain may contribute to the risk. The research, which included 84 UK care homes, found that residents taking multiple medicines had an increased risk of falling. Risk was also increased with a regular prescription for antidepressants or benzodiazepines (sedative or 31%) had one or more falls; the risk was higher in those taking antidepressants and sedatives; older residents were more likely to fall than their younger counterparts; men had more falls than women; residents with dementia had 75% more falls than those without dementia.
(Edited publisher abstract)
Falls among residents in UK care homes are commonplace. A new study examined whether multiple medications and drugs that act on the brain may contribute to the risk. The research, which included 84 UK care homes, found that residents taking multiple medicines had an increased risk of falling. Risk was also increased with a regular prescription for antidepressants or benzodiazepines (sedative drugs). Two-thirds of the residents in the study were living with dementia. Researchers suggest that care homes should emphasise non-drug approaches such as massage, music or art therapies. These interventions could help residents with depression and common symptoms of dementia such as agitation or sleep disturbance. Over a three-month period, the study found that: almost one in three residents (519 or 31%) had one or more falls; the risk was higher in those taking antidepressants and sedatives; older residents were more likely to fall than their younger counterparts; men had more falls than women; residents with dementia had 75% more falls than those without dementia.
(Edited publisher abstract)
Falls and fall related injuries are a common problem for older people. This article comments on evidence from a Swedish population-based, case-controlled study (See related link from the European Journal of Public Health), which has reconsidered the risk of falls associated with commonly prescribed medicines.
(Edited publisher abstract)
Falls and fall related injuries are a common problem for older people. This article comments on evidence from a Swedish population-based, case-controlled study (See related link from the European Journal of Public Health), which has reconsidered the risk of falls associated with commonly prescribed medicines.
(Edited publisher abstract)
Subject terms:
falls, prevention, medication, older people, risk;
NATIONAL INSTITUTE FOR HEALTH RESEARCH. Service Delivery and Organisation Programme
Publisher:
National Institute for Health Research. Service Delivery and Organisation Programme
Publication year:
2008
Pagination:
6p.
Place of publication:
London
The National Institute for Health Research has published the results of research looking into how fallers’ clinics function, and how their success can be measured so that an economic appraisal can be carried out. The National Service Framework (NSF) for Older People (2001) highlighted the need to reduce the health impact of falls, which led to the introduction of hundreds of fallers’ clinics throughout the UK. NICE published guidance on the operational aspects of running falls prevention services in 2004, but by this time the majority of clinics set up in the UK had their own specific approaches already in place. Although an economic analysis of these services was proposed in 2004, it was suspended due to the lack of evidence available at the time. The purpose of this research, therefore, was to increase the body of evidence on fallers’ clinics, to map out a model of service delivery, and to quantify the impact of these clinics on falls prevention, so that economic modelling would be possible. The most widespread interventions used in the clinics were found to be medication review, physical exercise and improving client knowledge. The authors note that determination of the true value
The National Institute for Health Research has published the results of research looking into how fallers’ clinics function, and how their success can be measured so that an economic appraisal can be carried out. The National Service Framework (NSF) for Older People (2001) highlighted the need to reduce the health impact of falls, which led to the introduction of hundreds of fallers’ clinics throughout the UK. NICE published guidance on the operational aspects of running falls prevention services in 2004, but by this time the majority of clinics set up in the UK had their own specific approaches already in place. Although an economic analysis of these services was proposed in 2004, it was suspended due to the lack of evidence available at the time. The purpose of this research, therefore, was to increase the body of evidence on fallers’ clinics, to map out a model of service delivery, and to quantify the impact of these clinics on falls prevention, so that economic modelling would be possible. The most widespread interventions used in the clinics were found to be medication review, physical exercise and improving client knowledge. The authors note that determination of the true value of a specific intervention was confounded by the lack of homogeneity in methodology between the different clinics, and conclude that further research in several key areas is needed to “generate high-quality data to tie together currently disparate evidence.
Subject terms:
intervention, literature reviews, medication, physical exercise, falls;
Health and Social Care in the Community, 23(6), 2015, p.594–604.
Publisher:
Wiley
The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34–1.95), poor dental health (aOR: 1.22; CI: 1.07–1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03–1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04–1.46) or living in a house (aOR: 1.28; CI: 1.02–1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11–1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.
(Publisher abstract)
The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34–1.95), poor dental health (aOR: 1.22; CI: 1.07–1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03–1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04–1.46) or living in a house (aOR: 1.28; CI: 1.02–1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11–1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.
(Publisher abstract)
Subject terms:
falls, older people, health, nutrition, medication, risk, home care;
Background: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available.
Objectives: To identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use.
Methods: Electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations.
Results: The authors selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life.
Conclusion: Little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed.
(Publisher abstract)
Background: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available.
Objectives: To identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use.
Methods: Electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations.
Results: The authors selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life.
Conclusion: Little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status.
(Publisher abstract)
Subject terms:
medication, older people, falls, cognitive impairment, end of life care, prevention, literature reviews;
International Journal of Geriatric Psychiatry, 26(6), June 2011, pp.602-607.
Publisher:
Wiley
The majority of fallers in hospitals are older people who have various medical conditions and are on several medications. This case-control study was carried out to analyse the role of medical conditions, and medication exposure within 24 hours, in the falls of older people in hospital. People aged 65 or over who were reported to the Taiwan Patient-Safety Reporting System for fall incidents in a large academic hospital in 2006 (n = 165) were included. They were individually matched with a control non-faller group. Bivariate analyses showed that older people with cancer, or exposure medications such as zolpidem, benzodiazepines, narcotics, and antihistamines were significantly more likely to have falls during hospitalisation. After controlling for cancer, zolpidem, narcotics, and antihistamine, benzodiazepine (OR = 2.26) and benzodiazepine doses 1 mg/day or more in diazepam equivalents (OR = 2.14) were still significantly associated with the falls of older people in the hospital. The authors suggest that strategies to prevent falls in older people in hospital should include minimising the use of zolpidem, benzodiazepine, narcotics, and antihistamines, especially in cancer patients.
The majority of fallers in hospitals are older people who have various medical conditions and are on several medications. This case-control study was carried out to analyse the role of medical conditions, and medication exposure within 24 hours, in the falls of older people in hospital. People aged 65 or over who were reported to the Taiwan Patient-Safety Reporting System for fall incidents in a large academic hospital in 2006 (n = 165) were included. They were individually matched with a control non-faller group. Bivariate analyses showed that older people with cancer, or exposure medications such as zolpidem, benzodiazepines, narcotics, and antihistamines were significantly more likely to have falls during hospitalisation. After controlling for cancer, zolpidem, narcotics, and antihistamine, benzodiazepine (OR = 2.26) and benzodiazepine doses 1 mg/day or more in diazepam equivalents (OR = 2.14) were still significantly associated with the falls of older people in the hospital. The authors suggest that strategies to prevent falls in older people in hospital should include minimising the use of zolpidem, benzodiazepine, narcotics, and antihistamines, especially in cancer patients.
Evidence-Based Interventions for Community Dwelling Older Adults presents an overview of significant evidence-based programs that can improve the health of seniors living in community-based settings. The book examines research conducted on a variety of health-related issues, including depression, care management, falls prevention, physical activity, and medications management. It also looks
Evidence-Based Interventions for Community Dwelling Older Adults presents an overview of significant evidence-based programs that can improve the health of seniors living in community-based settings. The book examines research conducted on a variety of health-related issues, including depression, care management, falls prevention, physical activity, and medications management. It also looks at research models that were translated into real-life practice settings, explores the benefits of implementing evidence-based models into care settings, and provides examples of how to adapt tested programs to meet local agency and population needs. The health care delivery system in the United States has embraced evidence-based medicine, largely based on its potential to reduce unwanted variations and keep a lid on escalating health care costs. But there are few resources available on how to gather information about model programs and even fewer on how to adapt them for practice. Evidence-Based Interventions for Community Dwelling Older Adults discusses how to effectively manage care beyond the hospital or clinic, as researchers, practitioners, policymakers, and academics provide an overview of evidence-based practice that works toward the best possible care for patients. The book also highlights the efforts of social workers, pharmacists, and case managers, and illustrates the importance of the leadership efforts of the Administration on Aging, National Council on Aging, and the Centers for Disease Control.
Subject terms:
intervention, medication, older people, adults, community care, falls, evidence-based practice;
International Journal of Geriatric Psychiatry, 27(1), January 2012, pp.76-82.
Publisher:
Wiley
Reported adverse events (RAEs) in hospitals include falls, drug and equipment related errors. The aim of this study was to determine the prevalence of RAEs in older acute medical inpatients and to investigate factors present at the time of hospital admission, in particular cognitive impairment or dementia, which may be associated with an increased risk of adverse events. A longitudinal cohort
Reported adverse events (RAEs) in hospitals include falls, drug and equipment related errors. The aim of this study was to determine the prevalence of RAEs in older acute medical inpatients and to investigate factors present at the time of hospital admission, in particular cognitive impairment or dementia, which may be associated with an increased risk of adverse events. A longitudinal cohort study took place in a large North London general hospital. The participants were 710 people aged over 70 years undergoing emergency medical admission. The participants were assessed using standardised tools for dementia and cognitive impairment. Data on adverse events was supplied independently by the hospital clinical risk department. The findings showed that 8.6% of patients experienced an RAE; 5.9% were patient-related and 2.7% system-related. Patient-related RAEs were associated with male gender, delirium, mild/moderate cognitive impairment and dementia. Staff comments on incident forms indicated an apparent lack of understanding of the impact of cognitive impairment. The article concludes that RAEs were common and associated with risk factors identifiable at admission.
NORTHERN IRELAND. Department of Health, Social Services and Public Safety
Publisher:
Northern Ireland. Department of Health, Social Services and Public Safety
Publication year:
2013
Pagination:
269
Place of publication:
Belfast
This Service Framework for Older People is one of a range of Service Frameworks which set out standards for health and social care to be used by patients, service users, carers and their wider families to help them understand the standard of care they can expect to receive in Northern Ireland. It sets standards in relation to people over 65 whilst taking account of the needs of those over 50, where appropriate, particularly in relation to preventative measures. The Framework sets standards in relation to: Person-centred Care; Health and Social Wellbeing Improvement; Safeguarding; Carers; Conditions more Common in Older People; Medicines Management and Transitions of Care. Each standard is accompanied by a statement on what the standard is intended to achieve. It also sets out the evidence base and rationale for the development of the standard, the impact of the standard on quality improvement as well as the performance indicators that will be used to measure that the standard during the three year period 2013 - 2016. The Framework has been developed by multidisciplinary Programme Board with the involvement of patients, users of services and their carers. The Framework will be regularly review in the light of new evidence.
(Edited publisher abstract)
This Service Framework for Older People is one of a range of Service Frameworks which set out standards for health and social care to be used by patients, service users, carers and their wider families to help them understand the standard of care they can expect to receive in Northern Ireland. It sets standards in relation to people over 65 whilst taking account of the needs of those over 50, where appropriate, particularly in relation to preventative measures. The Framework sets standards in relation to: Person-centred Care; Health and Social Wellbeing Improvement; Safeguarding; Carers; Conditions more Common in Older People; Medicines Management and Transitions of Care. Each standard is accompanied by a statement on what the standard is intended to achieve. It also sets out the evidence base and rationale for the development of the standard, the impact of the standard on quality improvement as well as the performance indicators that will be used to measure that the standard during the three year period 2013 - 2016. The Framework has been developed by multidisciplinary Programme Board with the involvement of patients, users of services and their carers. The Framework will be regularly review in the light of new evidence.
(Edited publisher abstract)
Subject terms:
older people, standards, person-centred care, safeguarding adults, carers, service transitions, medication, wellbeing, health, falls, end of life care, health care, social care, performance indicators;
Quality in Ageing and Older Adults, 13(3), 2012, pp.212-230.
Publisher:
Emerald
... of interventions: preventative home visits, integrated service delivery/case management and comprehensive geriatric assessment, falls prevention, exercise, nutritional needs, medication review, telecare/telehealth, social integration interventions, and vision screening. The authors discuss the findings and their implications for policies for healthy ageing. They report that the review identified areas of conflicting evidence and unknown effectiveness, partly due to lack of standardisation of outcome measures and poor research design, but that there are some promising interventions, such as integrated care delivery programmes, and there is evidence to support the implementation of exercise interventions, particularly for prevention of falls.
A literature review was undertaken to identify reviews and meta-analyses published between 1999 and 2009 on interventions aimed at preventing disablement in community-dwelling older people. This article presents an overview of the conclusions and quality of the 62 reviews selected for inclusion, and summarises the evidence for interventions. The selected reviews covered the following types of interventions: preventative home visits, integrated service delivery/case management and comprehensive geriatric assessment, falls prevention, exercise, nutritional needs, medication review, telecare/telehealth, social integration interventions, and vision screening. The authors discuss the findings and their implications for policies for healthy ageing. They report that the review identified areas of conflicting evidence and unknown effectiveness, partly due to lack of standardisation of outcome measures and poor research design, but that there are some promising interventions, such as integrated care delivery programmes, and there is evidence to support the implementation of exercise interventions, particularly for prevention of falls.