Anna-Liisa Juola1,2,3, Mikko P Bjorkman4,5, Sarita Pylkkanen6,7, Harriet Finne-Soveri8, Helena Soini9, Hannu Kautiainen10,11, J Simon Bell12,13,14, Kaisu H Pitkala15,16. 1. City of Porvoo, Health Sevices, PO Box 23, 06101, Porvoo, Finland. anna-liisa.juola@fimnet.fi. 2. Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. anna-liisa.juola@fimnet.fi. 3. Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. anna-liisa.juola@fimnet.fi. 4. Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. mikko.bjorkman@helsinki.fi. 5. Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. mikko.bjorkman@helsinki.fi. 6. Division of Social Pharmacy, Faculty of Pharmacy, University of Helsinki, PO Box 56, 00014, University of Helsinki, Finland. sarita.pylkkanen@carea.fi. 7. Carea Central Hospital Pharmacy, Kotkantie 41, 48210, Kotka, Finland. sarita.pylkkanen@carea.fi. 8. National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland. harriet.finne-soveri@thl.fi. 9. Social Services and Health Care Department, 4 A, PO Box 8555, 00099, City of Helsinki, Finland. helena.soini@hel.fi. 10. Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. hannu.kautiainen@medcare.fi. 11. Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. hannu.kautiainen@medcare.fi. 12. Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia. Simon.Bell@unisa.edu.au. 13. School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia. Simon.Bell@unisa.edu.au. 14. Faculty of Health Sciences, Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. Simon.Bell@unisa.edu.au. 15. Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi. 16. Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi.
Abstract
BACKGROUND:Psychotropic and anticholinergic medications may increase the risk of falls and impair cognition. OBJECTIVE: The aim of the study was to investigate whether educating nursing staff in assisted living facilities about harmful medication use has effects on the incidence of falls and cognition. METHODS: This was a secondary analysis of a cluster randomized controlled trial (N = 227 residents, ≥65 years) in 20 wards in assisted living facilities in Helsinki, Finland. Wards were randomized to those in which staff received two 4-h interactive training sessions to recognize potentially harmful medications (intervention group) and a control group. Cognition (verbal fluency, clock-drawing test) was assessed at baseline and 6 and 12 months. The number of falls per resident over the 12-month follow-up was recorded. RESULTS: The prevalence of harmful medication use declined in the intervention group {-11.7% [95% confidence interval (CI) -20.5 to -2.9]; p = 0.009}, but remained constant in the control group [+3.4% (95% CI -3.7 to 10.6); p = 0.34]. There were 171 falls in the intervention group (2.25 falls/person year, 95% CI 1.93-2.62) and 259 falls in the control group (3.25 falls/person year, 95% CI 2.87-3.67) [incidence rate ratio 0.72 (95% CI 0.59-0.88); p < 0.001]. Residents in the intervention group with a Mini-Mental State Examination (MMSE) score ≥10 had significantly less falls compared with respective residents in the control group (p < 0.001). Changes in verbal fluency or clock drawing test were not significantly different between the groups. CONCLUSION: Educating nurses using activating learning methods can reduce the prevalence of harmful medications and the incidence of falls among residents in institutional settings.
RCT Entities:
BACKGROUND: Psychotropic and anticholinergic medications may increase the risk of falls and impair cognition. OBJECTIVE: The aim of the study was to investigate whether educating nursing staff in assisted living facilities about harmful medication use has effects on the incidence of falls and cognition. METHODS: This was a secondary analysis of a cluster randomized controlled trial (N = 227 residents, ≥65 years) in 20 wards in assisted living facilities in Helsinki, Finland. Wards were randomized to those in which staff received two 4-h interactive training sessions to recognize potentially harmful medications (intervention group) and a control group. Cognition (verbal fluency, clock-drawing test) was assessed at baseline and 6 and 12 months. The number of falls per resident over the 12-month follow-up was recorded. RESULTS: The prevalence of harmful medication use declined in the intervention group {-11.7% [95% confidence interval (CI) -20.5 to -2.9]; p = 0.009}, but remained constant in the control group [+3.4% (95% CI -3.7 to 10.6); p = 0.34]. There were 171 falls in the intervention group (2.25 falls/person year, 95% CI 1.93-2.62) and 259 falls in the control group (3.25 falls/person year, 95% CI 2.87-3.67) [incidence rate ratio 0.72 (95% CI 0.59-0.88); p < 0.001]. Residents in the intervention group with a Mini-Mental State Examination (MMSE) score ≥10 had significantly less falls compared with respective residents in the control group (p < 0.001). Changes in verbal fluency or clock drawing test were not significantly different between the groups. CONCLUSION: Educating nurses using activating learning methods can reduce the prevalence of harmful medications and the incidence of falls among residents in institutional settings.
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