Nurse Education to Reduce Harmful Medication Use in Assisted Living Facilities: Effects of a Randomized Controlled Trial on Falls and Cognition

Anna-Liisa Juola, Mikko P Bjorkman, Sarita Pylkkanen, Harriet U Finne-Soveri, Helena H Soini, Hannu Kautiainen, J Simon Bell, Kaisu Hannele Pitkala

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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.
Original languageEnglish
Pages (from-to)947–955
Number of pages9
JournalDrugs & Aging
Volume32
Issue number11
DOIs
Publication statusPublished - 2015

Cite this

Juola, A-L., Bjorkman, M. P., Pylkkanen, S., Finne-Soveri, H. U., Soini, H. H., Kautiainen, H., Bell, J. S., & Pitkala, K. H. (2015). Nurse Education to Reduce Harmful Medication Use in Assisted Living Facilities: Effects of a Randomized Controlled Trial on Falls and Cognition. Drugs & Aging, 32(11), 947–955. https://doi.org/10.1007/s40266-015-0311-8