@article{ref1,
title="The association between central nervous system-active medication use and fall-related injury in community-dwelling older adults with dementia",
journal="Pharmacotherapy",
year="2019",
author="Hart, Laura A. and Marcum, Zachary A. and Gray, Shelly L. and Walker, Rod L. and Crane, Paul K. and Larson, Eric B.",
volume="39",
number="5",
pages="530-543",
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. <br><br>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. <br><br>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). <br><br>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.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0277-0008",
doi="10.1002/phar.2244",
url="http://dx.doi.org/10.1002/phar.2244"
}