Published in:
01-11-2015 | Original Research Article
Nurse Education to Reduce Harmful Medication Use in Assisted Living Facilities: Effects of a Randomized Controlled Trial on Falls and Cognition
Published in: Drugs & Aging | Issue 11/2015
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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.