Neuropsychiatric Symptoms as Predictors of Falls in Long-Term Care Residents With Cognitive Impairment

Objectives: Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. Design: Longitudinal cohort study. Setting and Participants: In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. Methods: NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0-3), low NPS burden (NPI 4-12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Results: Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P <.001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. Conclusions and Implications: The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities

Objectives: To compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality. Design: Cross-sectional study and 1-year follow-up of all-cause mortality. Setting and Participants: Of all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (>= 65 years of age) participated after exclusion of residents with severe dementia. Measurements: Data on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers. Results: Of all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality. Conclusions and Implications: DAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

Temporal Trends Over Two Decades in the Use of Anticholinergic Drugs Among Older Community-Dwelling People in Helsinki, Finland

Background Knowledge of the adverse effects of drugs with anticholinergic properties (DAPs) has increased in recent decades. However, research on the temporal trends of the clinical use of DAPs is still sparse. Objectives The aim of this study was to investigate the temporal trends of DAP use over two decades in the older community-dwelling population and to explore the medication classes contributing to the use of DAPs. Methods The study involved random samples of >= 75-year-old community-dwelling Helsinki citizens in 1999, 2009, and 2019 from the Helsinki Ageing Study. A postal questionnaire inquired about their health, functioning, and medications. The medications were categorized as DAPs according to Duran's list. In addition, we grouped DAPs into various medication groups. Results The prevalence and burden of DAPs on Duran's list showed a decreasing trend over the years. In 1999 the prevalence was 20% and the burden 0.35, in 2009 they were 22% and 0.35, respectively, and in 2019 they were 16% and 0.23, respectively. There were no differences in how the 75- and 80-year-olds used DAPs compared with those aged 85 years and older. The proportion of typical antipsychotics, benzodiazepines, hypnotics, urinary antispasmodics, and asthma/chronic obstructive pulmonary disease medications decreased, whereas the proportion of atypical antipsychotics, antidepressants, strong opioids, and antihistamines increased. In particular the use of mirtazapine increased-to 3.9% in 2019. In 2019 the three most prevalent groups of DAPs were antidepressants (7.4%), opioids (2.7%), and antihistamines (2.4%). Conclusions The decrease in the use of DAPs on Duran's list is a welcome change. Although the use of old, strong DAPs has decreased, new DAPs have simultaneously emerged. Physicians need continuous education in prescribing DAPs and more recent information on the use and effects of DAPs is needed in order to decrease their exposure among the rapidly growing older population.Peer reviewe

Changes in symptom burden from 2019 to 2021 amongst community-dwelling older adults in Finland

Background Symptom burden causes suffering amongst older adults and is associated with healthcare visits and prognosis. Aims We evaluated the prevalence of 10 symptoms and changes in symptom burden amongst home-dwelling older adults in 2019 and 2021 using Finnish cohort data. We analysed factors associated with symptom burden increase during follow-up. Methods Altogether 1,637 people aged 75+ participated in the Helsinki Ageing Study postal survey in 2019, where they reported the presence of 10 common symptoms over the past 2 weeks. Of them, 785 participated in a follow-up in 2021, where the same symptoms were queried. We compared the prevalence of various symptoms and symptom burden scores in the 2-year interval and evaluated factors associated with increased symptom burden during this time. Results Of participants, 33% reported at least one daily symptom in 2019 versus 44% in 2021. Symptom burden increased by a mean ratio of 1.29 between 2019 and 2021. The most common symptoms were joint pain, back pain, urinary incontinence and fatigue. The prevalence of four symptoms increased between 2019 and 2021: joint pain, urinary incontinence, dizziness and shortness of breath. Higher age, reduced functional capacity and comorbidities were associated with higher odds of symptom burden increase during follow-up. Psychological well-being (PWB) was strongly associated with lower odds of symptom burden increase in the logistic regression model. Conclusions Symptom burden increased in our cohort aged 75+ between 2019 and 2021 before and during the COVID-19 pandemic. PWB was associated with lower odds of acquiring additional symptoms over time.Peer reviewe

Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer's Disease : Does Exercise Modify the Risk?

Peer reviewe

Effect of Exercise on Drug-Related Falls Among Persons with Alzheimer's Disease : A Secondary Analysis of the FINALEX Study

Introduction No study has investigated how exercise modifies the effect of fall-related drugs (FRDs) on falls among people with Alzheimer's disease (AD). Objective The aim of this study was to investigate how exercise intervention and FRDs interact with fall risk among patients with AD. Methods In the FINALEX trial, community-dwelling persons with AD received either home-based or group-based exercise twice weekly for 1 year (n = 129); the control group received normal care (n = 65). The number of falls was based on spouses' fall diaries. We examined the incidence rate ratios (IRRs) for falls among both non-users and users of various FRDs (antihypertensives, psychotropics, drugs with anticholinergic properties [DAPs]) in both control and combined intervention groups. Results Between the intervention and control groups, there was no difference in the number of falls among those without antihypertensives or psychotropics. In the intervention group taking antihypertensives, the IRR was 0.5 falls/person-year (95% confidence interval [CI] 0.4-0.6), while in the control group, the IRR was 1.5 falls/person-year (95% CI 1.2-1.8) [p <0.001 for group, p = 0.067 for medication, p <0.001 for interaction]. Among patients using psychotropics, the intervention group had an IRR of 0.7 falls/person-year (95% CI 0.6-0.9), while the control group had an IRR of 2.0 falls/person-year (95% CI 1.6-2.5) [p <0.001 for group, p = 0.071 for medication, p <0.001 for interaction]. There was a significant difference in falls between the intervention and control groups not using DAPs (0.6, 95% CI 0.5-0.7; 1.2, 95% CI 1.0-1.4), and between the intervention and control groups using DAPs (1.1, 95% CI 0.8-1.3; 1.5, 95% CI 1.0-2.1) [p <0.001 for group, p = 0.014 for medication, p = 0.97 for interaction]. Conclusion Exercise has the potential to decrease the risk for falls among people with AD using antihypertensives and psychotropics.Peer reviewe

Eurooppalaisessa SPRINTT-tutkimuksessa selvitetään gerastenian ehkäisyä liikunta- ja ravitsemusintervention avulla

Maailmanlaajuisesti &gt;60-vuotiaiden osuus väestöstä kasvaa nopeasti, mikä asettaa haasteita terveydenhuoltopalveluille. Haurastuminen eli gerastenia on yleistä vanhimmilla ikäihmisillä ja se johtaa fyysisen toimintakyvyn heikkenemiseen, lisää kaatumisriskiä, sosiaalista syrjäytymistä, heikentää elämänlaatua, lisää avun sekä laitoshoidon tarvetta. Liikkumiskyvyn ylläpitäminen on tärkeää, koska siten voidaan katkaista haurastumiseen johtava kierre. Yhteiseurooppalainen SPRINTT-projekti pyrkii kaksi vuotta kestävässä, satunnaistetussa, kontrolloidussa, liikuntaan ja ravitsemukseen pohjautuvassa interventiotutkimuksessa ehkäisemään ja hidastamaan liikkumiseen liittyviä toiminnanvajeita ≥70-vuotiailla henkilöillä, joilla jo on gerastenian merkkejä. Tutkimuksessa rekrytoidaan noin 1500 osallistujaa yhdestätoista Euroopan maasta. Interventioryhmän tutkittavat saavat yksilöityä ravitsemusneuvontaa, käyvät heille järjestetyssä liikuntaryhmissä ja toteuttavat kotiharjoitteluohjelmaa. Verrokkiryhmälle järjestetään kerran kuussa luentoja terveyteen ja hyvinvointiin liittyvistä teemoista. Päätulosmuuttujana tutkimuksessa on liikkumiskyky, jota mitataan 400 metrin kävelytestillä. Muita tulosmuuttujia ovat esimerkiksi muutokset lihasmassassa ja- voimassa, kaatumiset, kognitio, terveyspalvelujen käyttö ja elämänlaatu. SPRINTT-tutkimuksen tulosten odotetaan tuottavan tietoa, joka auttaa kehittämään gerastenian hoitoa sekä ehkäisemään liikkumiskyvyn heikkenemistä gerasteniariskissä olevilla ikäihmisillä. Lisäksi tutkimuksen tavoitteena on kehittää yleisesti hyväksytty määritelmä gerastenialle

Association of medication use with falls and mortality among long-term care residents : a longitudinal cohort study

BackgroundFalls in long-term care are common. The aim of our study was to explore how medication use is associated with incidence of falls, related consequences, and all-cause mortality among long-term care residents.MethodsFive hundred thirty two long-term care residents aged 65 years or older participated in this longitudinal cohort study in 2018-2021. Data on medication use were retrieved from medical records. Polypharmacy was defined as use of 5-10 medications and excessive polypharmacy as use of > 10 medications. The numbers of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Participants were followed for three years for mortality. All analysis were adjusted for age, sex, Charlson Comorbidity Index, Clinical dementia rating, and mobility.ResultsA total of 606 falls occurred during the follow-up. Falls increased significantly with the number of medications used. Fall rate was 0.84/person-years (pyrs) (95% CI 0.56 to 1.13) for the non-polypharmacy group, 1.13/pyrs (95% CI 1.01 to 1.26) for the polypharmacy group, and 1.84/pyrs (95% CI 1.60 to 2.09) for the excessive polypharmacy group. Incidence rate ratio for falls was 1.73 (95% CI 1.44 to 2.10) for opioids, 1.48 (95% CI 1.23 to 1.78) for anticholinergic medication, 0.93 (95% CI 0.70 to 1.25) for psychotropics, and 0.91 (95% CI 0.77 to 1.08) for Alzheimer medication. The three-year follow-up showed significant differences in mortality between the groups, the lowest survival rate (25%) being in the excessive polypharmacy group.ConclusionPolypharmacy, opioid and anticholinergic medication use predicted incidence of falls in long-term care. The use of more than 10 medications predicted all-cause mortality. Special attention should be paid to both number and type of medications when prescribing in long-term care.Peer reviewe

Eurooppalaisessa SPRINTT-tutkimuksessa selvitetään gerastenian ehkäisyä liikunta- ja ravitsemusintervention avulla

Maailmanlaajuisesti &gt;60-vuotiaiden osuus väestöstä kasvaa nopeasti, mikä asettaa haasteita terveydenhuoltopalveluille. Haurastuminen eli gerastenia on yleistä vanhimmilla ikäihmisillä ja se johtaa fyysisen toimintakyvyn heikkenemiseen, lisää kaatumisriskiä, sosiaalista syrjäytymistä, heikentää elämänlaatua, lisää avun sekä laitoshoidon tarvetta. Liikkumiskyvyn ylläpitäminen on tärkeää, koska siten voidaan katkaista haurastumiseen johtava kierre. Yhteiseurooppalainen SPRINTT-projekti pyrkii kaksi vuotta kestävässä, satunnaistetussa, kontrolloidussa, liikuntaan ja ravitsemukseen pohjautuvassa interventiotutkimuksessa ehkäisemään ja hidastamaan liikkumiseen liittyviä toiminnanvajeita ≥70-vuotiailla henkilöillä, joilla jo on gerastenian merkkejä. Tutkimuksessa rekrytoidaan noin 1500 osallistujaa yhdestätoista Euroopan maasta. Interventioryhmän tutkittavat saavat yksilöityä ravitsemusneuvontaa, käyvät heille järjestetyssä liikuntaryhmissä ja toteuttavat kotiharjoitteluohjelmaa. Verrokkiryhmälle järjestetään kerran kuussa luentoja terveyteen ja hyvinvointiin liittyvistä teemoista. Päätulosmuuttujana tutkimuksessa on liikkumiskyky, jota mitataan 400 metrin kävelytestillä. Muita tulosmuuttujia ovat esimerkiksi muutokset lihasmassassa ja- voimassa, kaatumiset, kognitio, terveyspalvelujen käyttö ja elämänlaatu. SPRINTT-tutkimuksen tulosten odotetaan tuottavan tietoa, joka auttaa kehittämään gerastenian hoitoa sekä ehkäisemään liikkumiskyvyn heikkenemistä gerasteniariskissä olevilla ikäihmisillä. Lisäksi tutkimuksen tavoitteena on kehittää yleisesti hyväksytty määritelmä gerastenialle

Neuropsychiatric symptoms as predictors of falls in long-term care residents with cognitive impairment

Abstract Objectives: Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. Design: Longitudinal cohort study. Setting and Participants: In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. Methods: NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0‒3), low NPS burden (NPI 4‒12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Results: Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P &lt; .001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. Conclusions and Implications: The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment