Medications as Acute Precipitants of Falls in the Nursing Home Setting

描述（由申请人提供）：Sarah Berry博士是哈佛医学院训练有素的老年医学专家和希伯来康复中心的医学讲师。Berry博士的长期目标是成为一名学术老年病专家和独立调查员，在流行病学和跌倒和骨折的结果方面具有专业知识。她以前的工作主要集中在老年人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关注骨骼强度，还要关注预防跌倒。药物使用是养老院环境中跌倒的常见和潜在的可改变的风险因素。因此，她学习课程的主要目标是增加她在预防跌倒和药物流行病学方面的知识，并提高她在研究设计方法方面的技能。本研究项目的目的是描述养老院人群中药物变化的频率，并确定药物变化对急性跌倒风险的影响，采用独特而适当的研究设计：病例交叉研究。申请人还将评估特定药物变化对急性跌倒风险的影响，在门诊居民中是否比在非门诊居民中更大，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影响的估计将通过比较跌倒前一段时间内药物变化的频率，并将其与同一个体在非跌倒期间药物变化的频率进行比较来确定。这个以患者为导向的职业发展指导奖将提供必要的额外培训，以发展成为老龄化领域的独立研究者，拟议的项目将为申请人提供几份手稿和初步数据，以便在该奖项的最后一年撰写并提交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.