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Fall‐Related Hospitalizations in Nursing Home Residents Co‐Prescribed a Cholinesterase Inhibitor and Beta‐Blocker
Author(s) -
Watt Jennifer A.,
Campitelli Michael A.,
Maxwell Colleen J.,
Guan Jun,
Maclagan Laura C.,
Gomes Tara,
Bokhari Mahmoud,
Straus Sharon E.,
Bronskill Susan E.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16710
Subject(s) - medicine , odds ratio , emergency department , dementia , confidence interval , medical prescription , cohort , population , cohort study , emergency medicine , disease , psychiatry , nursing , environmental health
BACKGROUND/OBJECTIVES To examine the association between hospitalization for a fall‐related injury and the co‐prescription of a cholinesterase inhibitor (ChEI) among persons with dementia receiving a beta‐blocker, and whether this potential drug‐drug interaction is modified by frailty. DESIGN Nested case‐control study using population‐based administrative databases. SETTING All nursing homes in Ontario, Canada. PARTICIPANTS Persons with dementia aged 66 and older who received at least one beta‐blocker between April 2013 and March 2018 following nursing home admission (n = 19,060). MEASUREMENTS Cases were persons with dementia with a hospitalization (emergency department visit or acute care admission) for a fall‐related injury with concurrent beta‐blocker use. Each case (n = 3,038) was matched 1:1 to a control by age (±1 year), sex, cohort entry year, frailty, and history of fall‐related injuries. The association between fall‐related injury and exposure to a ChEI in the 90 days prior was examined using multivariable conditional logistic regression. Secondary exposures included ChEI type, daily dose, incident versus prevalent use, and use in the prior 30 days. Subgroup analyses considered frailty, age group, sex, and history of hospitalization for fall‐related injuries. RESULTS Exposure to a ChEI in the prior 90 days occurred among 947 (31.2%) cases and 940 (30.9%) controls. In multivariable models, no association was found between hospitalization for a fall‐related injury and prior exposure to a ChEI in persons with dementia dispensed beta‐blockers (adjusted odds ratio = .96, 95% confidence interval = .85–1.08). Findings were consistent across secondary exposures and subgroup analyses. CONCLUSION Among nursing home residents with dementia receiving beta‐blockers, co‐prescription of a ChEI was not associated with an increased risk of hospitalization for a fall‐related injury. However, we did not assess for its association with falls not leading to hospitalization. This finding could inform clinical guidelines and shared decision making between persons with dementia, caregivers, and clinicians concerning ChEI initiation and/or discontinuation.