Change in central nervous system‐active medication use following fall‐related injury in older adults

Author(s):  
Laura A. Hart ◽  
Rod Walker ◽  
Elizabeth A. Phelan ◽  
Zachary A. Marcum ◽  
Naomi R. M. Schwartz ◽  
...  
2017 ◽  
Vol 13 (7) ◽  
pp. P1564-P1565
Author(s):  
Laura A. Hart ◽  
Zachary Marcum ◽  
Shelly L. Gray ◽  
Rod L. Walker ◽  
Paul K. Crane ◽  
...  

2019 ◽  
Vol 75 (5) ◽  
pp. 1003-1009 ◽  
Author(s):  
Shelly L Gray ◽  
Zachary A Marcum ◽  
Sascha Dublin ◽  
Rod Walker ◽  
Negar Golchin ◽  
...  

Abstract Background It is well established that individual medications that affect the central nervous system (CNS) increase falls risk in older adults. However, less is known about risks associated with taking multiple CNS-active medications. Methods Employing a new user design, we used data from the Adult Changes in Thought study, a prospective cohort of community-dwelling people aged 65 and older without dementia. We created a time-varying composite measure of CNS-active medication exposure from electronic pharmacy fill data and categorized into mutually exclusive categories: current (within prior 30 days), recent (31–90 days), past (91–365 days), or nonuse (no exposure in prior year). We calculated standardized daily dose and identified new initiation. Cox proportional hazards models examined the associations between exposures and the outcome of fall-related injury identified from health plan electronic databases. Results Two thousand five hundred ninety-five people had 624 fall-related injuries over 15,531 person-years of follow-up. Relative to nonuse, fall-related injury risk was significantly greater for current use of CNS-active medication (hazard ratio [HR] = 1.95; 95% CI = 1.57–2.42), but not for recent or past use. Among current users, increased risk was noted with all doses. Risk was increased for new initiation compared with no current use (HR = 2.81; 95% CI = 2.09–3.78). Post hoc analyses revealed that risk was especially elevated with new initiation of opioids. Conclusions We found that current use, especially new initiation, of CNS-active medications was associated with fall-related injury in community-dwelling older adults. Increased risk was noted with all dose categories. Risk was particularly increased with new initiation of opioids.


Author(s):  
Jesse K Siegel ◽  
Xiandao Yuan ◽  
Kristen E Wroblewski ◽  
Martha K McClintock ◽  
Jayant M Pinto

Abstract Background Sleep-disordered breathing (SDB) is a common, underdiagnosed condition in older adults with major health consequences, including disrupted central nervous system functioning. Whether SDB may affect sensory function is unclear. We sought to address this question by comparing 2 forms of olfactory testing which measure peripheral and central olfactory processing. Methods We assessed SDB (survey-reported snoring frequency, nighttime apneic events, or diagnosis of sleep apnea) in the National Social Life, Health, and Aging Project, a nationally representative sample of older U.S. adults. Odor sensitivity (peripheral) and odor identification (central) were assessed with validated instruments. Logistic regression was used to test the relationship between SDB and olfaction, accounting for relevant covariates, including demographics, cognition, and comorbidity. Results Twenty-nine percent of older U.S. adults reported symptoms of SDB (apneic events or nightly snoring). Of these, only 32% had been diagnosed with sleep apnea. Older adults with SDB (those who reported symptoms or have been diagnosed with sleep apnea) were significantly more likely to have impaired odor identification (odds ratio 2.13, 95% confidence interval 1.19–3.83, p = .012) in analyses that accounted for age, gender, race/ethnicity, education, cognition, comorbidities (including depression), and body mass index. Presence of SDB was not associated with impaired odor sensitivity (odds ratio 1.03, 95% confidence interval 0.75–1.43, p = .84). Conclusion SDB is highly prevalent but underdiagnosed in older U.S. adults and is associated with impaired odor identification but not odor sensitivity. These data support the concept that SDB affects pathways in the central nervous system which involve chemosensory processing.


2017 ◽  
Vol 49 (1-2) ◽  
pp. 82-90 ◽  
Author(s):  
Syed Shahzad Hasan ◽  
Chia Siang Kow ◽  
Kaeshaelya Thiruchelvam ◽  
David Weng Kwai Chong ◽  
Syed Imran Ahmed

2015 ◽  
Vol 70 (12) ◽  
pp. 1526-1532 ◽  
Author(s):  
Farzaneh A. Sorond ◽  
Yenisel Cruz-Almeida ◽  
David J. Clark ◽  
Anand Viswanathan ◽  
Clemens R. Scherzer ◽  
...  

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