2.50
Hdl Handle:
http://hdl.handle.net/10755/157319
Type:
Presentation
Title:
MECHANISMS OF MEDICATION-RELATED FALLS IN OLDER ADULTS
Abstract:
MECHANISMS OF MEDICATION-RELATED FALLS IN OLDER ADULTS
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Pepper, Ginette A., PhD, RN, FAAN
P.I. Institution Name:University of Utah
Title:Endowed Chair & Associate Dean for Research
Contact Address:10 S 2000 E, Salt Lake City, UT, 84112, USA
Co-Authors:Bob Wong; Gail Towsley; Janelle Bassett
PURPOSES/AIMS: The purpose of this pilot study was to determine if muscarinic blockade is a viable hypothesis for the pharmacologic mechanism of drug-related falls in older adults.
RATIONALE/CONCEPTUAL BASIS/BACKGROUND: Studies of medication-related falls yield contradictory results which may be attributable to classification of drugs by therapeutic group, rather than pharmacologic mechanism in previous studies. Three candidate pharmacologic mechanisms of drug-related falling are muscarinic blockage ("anticholinergic"), sedation, and orthostatic hypotension. Unstable balance and fear of falling are likely mediators between drug mechanism and falling.
METHODS: Using longitudinal, descriptive, correlational design, a sample of 47 adults>70 years (mean 78.3years; 75% female) taking medications associated with falling were assessed on predictor variables of demographics, functional status, depression (GDS-SF), cognitive function (MMSE), postural hypotension, sedation (MRS, DSST) and anticholinergic burden score. Dependent variables were postural sway, dynamic balance, and fear of falling (MFES). Fall events were ascertained over a one year period by diaries and telephone interview.
RESULTS: Neither cumulative anticholinergic burden, highest potency, nor number of anticholineric agents used were associated with fall events. There were no differences in balance parameters between putative peak and trough of drug action. In multivariate analysis imbalance was predicted by postural hypotension and use of anticholinergic drug(s) (R2=22%, p<.05). The only predictor of incidence of fall events was DSST sedation (R2=14%, p=.039), while age, MRS and postural hypotension predicted fear of falling (R2=50.2%; p<.001). Univariate analysis implicated a role for sedation. Fall events were associated with sedation (p=.05) and history of falling (pr= 45; p<.001) and postural hypotension (r=0.35; pr=0.47; p<.001), while postural hypotension was associated with sway (r=.30; p<.05).
IMPLICATIONS: Muscarinic blockade is one possible mechanism of drug-related falling, though a larger study is needed to determine the relative contributions of various pharmacologic mechanisms, due to overlapping drug effects. Results suggest health care providers should assess for postural hypotension and minimize the anticholinergic and sedative burden of medication regimens. Genetic research and personalized medicine frameworks may be useful avenues for future research on pharmacologic mechanisms of drug-related falling. Funded by NIH R15NR05136.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleMECHANISMS OF MEDICATION-RELATED FALLS IN OLDER ADULTSen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157319-
dc.description.abstract<table><tr><td colspan="2" class="item-title">MECHANISMS OF MEDICATION-RELATED FALLS IN OLDER ADULTS</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Pepper, Ginette A., PhD, RN, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Utah</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Endowed Chair &amp; Associate Dean for Research</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">10 S 2000 E, Salt Lake City, UT, 84112, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ginny.pepper@nurs.utah.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Bob Wong; Gail Towsley; Janelle Bassett</td></tr><tr><td colspan="2" class="item-abstract">PURPOSES/AIMS: The purpose of this pilot study was to determine if muscarinic blockade is a viable hypothesis for the pharmacologic mechanism of drug-related falls in older adults. <br/>RATIONALE/CONCEPTUAL BASIS/BACKGROUND: Studies of medication-related falls yield contradictory results which may be attributable to classification of drugs by therapeutic group, rather than pharmacologic mechanism in previous studies. Three candidate pharmacologic mechanisms of drug-related falling are muscarinic blockage (&quot;anticholinergic&quot;), sedation, and orthostatic hypotension. Unstable balance and fear of falling are likely mediators between drug mechanism and falling. <br/>METHODS: Using longitudinal, descriptive, correlational design, a sample of 47 adults&gt;70 years (mean 78.3years; 75% female) taking medications associated with falling were assessed on predictor variables of demographics, functional status, depression (GDS-SF), cognitive function (MMSE), postural hypotension, sedation (MRS, DSST) and anticholinergic burden score. Dependent variables were postural sway, dynamic balance, and fear of falling (MFES). Fall events were ascertained over a one year period by diaries and telephone interview.<br/>RESULTS: Neither cumulative anticholinergic burden, highest potency, nor number of anticholineric agents used were associated with fall events. There were no differences in balance parameters between putative peak and trough of drug action. In multivariate analysis imbalance was predicted by postural hypotension and use of anticholinergic drug(s) (R2=22%, p&lt;.05). The only predictor of incidence of fall events was DSST sedation (R2=14%, p=.039), while age, MRS and postural hypotension predicted fear of falling (R2=50.2%; p&lt;.001). Univariate analysis implicated a role for sedation. Fall events were associated with sedation (p=.05) and history of falling (pr= 45; p&lt;.001) and postural hypotension (r=0.35; pr=0.47; p&lt;.001), while postural hypotension was associated with sway (r=.30; p&lt;.05). <br/>IMPLICATIONS: Muscarinic blockade is one possible mechanism of drug-related falling, though a larger study is needed to determine the relative contributions of various pharmacologic mechanisms, due to overlapping drug effects. Results suggest health care providers should assess for postural hypotension and minimize the anticholinergic and sedative burden of medication regimens. Genetic research and personalized medicine frameworks may be useful avenues for future research on pharmacologic mechanisms of drug-related falling. Funded by NIH R15NR05136.<br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:45:54Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:45:54Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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