Medications as Acute Precipitants of Falls in the Nursing Home Setting

描述(申请人提供)：莎拉·贝瑞博士是哈佛医学院毕业的老年病学家，也是希伯来康复中心的医学讲师。贝瑞博士的长期目标是成为一名学术老年病学家和独立研究员，在跌倒和骨折的流行病学和结果方面拥有专业知识。她之前的工作主要集中在老年人第二次骨折的流行病学上。重要的是，未来预防骨折的努力不仅要注重骨骼强度，还要注重预防跌倒。药物使用是疗养院环境中跌倒的一个常见的、潜在的可改变的危险因素。因此，她的学习课程的主要目标是增加她的预防跌倒和药物流行病学的知识，并提高她在研究设计方法方面的技能。这项研究项目的目的是描述疗养院人群中药物变化的频率，并使用一种独特和适当的研究设计：病例交叉研究来确定药物变化对急性跌倒风险的影响。申请者还将评估特定药物变化对跌倒急性风险的影响是否在非流动居民中更大，在基线药物使用量高的居民中是否比基线药物使用量低的居民更大。对药物变化对跌倒风险的影响的估计将通过比较跌倒前一段时间内的药物变化频率，并将其与同一人在非跌倒期间的药物变化频率进行比较来确定。这个以患者为导向的导师职业发展奖将提供必要的额外培训，以发展成为老龄领域的独立调查员，拟议的项目将产生几份手稿和初步数据，供申请者在奖项的最后一年撰写和提交R01申请。

DESCRIPTION (provided by applicant): Dr. Sarah Berry is a Harvard Medical School trained Geriatrician and Instructor in Medicine at Hebrew Rehabilitation Center. Dr. Berry's long term objective is to become an academic geriatrician and independent investigator with expertise in the epidemiology and outcomes of falls and fractures. Her previous work has focused largely on the epidemiology of second fractures in elderly persons. It is important that future efforts to prevent fractures focus not only on bone strength, but on fall prevention as well. Medication use is a common and potentially modifiable risk factor for falls in the nursing home setting. Therefore, the primary objectives of her learning curriculum are to increase her knowledge of fall prevention and pharmacoepidemiology, and to improve her skills in study design methodology. The aims of this research project are to describe the frequency of medication changes in the nursing home population, and to determine the effects of medication changes on the acute risk of falls using a unique and appropriate study design: the case-crossover study. The applicant will also assess whether the effects of a particular medication change on the acute risk of falls is greater among ambulatory residents compared with non-ambulatory residents, and among residents with high baseline medication use compared to residents with low baseline medication use. The estimate of the effect of medication changes on the risk of falls will be determined by comparing the frequency of medication changes during the time period just prior to the fall, and comparing this with the frequency of medication changes during non-fall periods in the same individual. This Mentored Patient-Oriented Career Development Award will provide the necessary additional training to develop into an independent investigator in the field of aging, and the proposed project will produce several manuscripts and preliminary data for the applicant to write and submit an R01 application by the final year of the award.