title: Nurse Education to Reduce Harmful Medication Use in Assisted Living Facilities: Effects of a Randomized Controlled Trial on Falls and Cognition.
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.
  
  
  CONCLUSIONS
  Educating nurses using activating learning methods can reduce the prevalence of harmful medications and the incidence of falls among residents in institutional settings.
authors.affiliation: City of Porvoo, Health Sevices, PO Box 23, 06101, Porvoo, Finland. anna-liisa.juola@fimnet.fi.|Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. anna-liisa.juola@fimnet.fi.|Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. anna-liisa.juola@fimnet.fi.
authors.forename: Anna-Liisa
authors.identifier: http://orcid.org/0000-0002-0081-929X
authors.initials: AL
authors.lastname: Juola
authors.affiliation: Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. mikko.bjorkman@helsinki.fi.|Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. mikko.bjorkman@helsinki.fi.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Bjorkman
authors.affiliation: Division of Social Pharmacy, Faculty of Pharmacy, University of Helsinki, PO Box 56, 00014, University of Helsinki, Finland. sarita.pylkkanen@carea.fi.|Carea Central Hospital Pharmacy, Kotkantie 41, 48210, Kotka, Finland. sarita.pylkkanen@carea.fi.
authors.forename: Sarita
authors.initials: S
authors.lastname: Pylkkanen
authors.affiliation: National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland. harriet.finne-soveri@thl.fi.
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.affiliation: Social Services and Health Care Department, 4 A, PO Box 8555, 00099, City of Helsinki, Finland. helena.soini@hel.fi.
authors.forename: Helena
authors.initials: H
authors.lastname: Soini
authors.affiliation: Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. hannu.kautiainen@medcare.fi.|Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. hannu.kautiainen@medcare.fi.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia. Simon.Bell@unisa.edu.au.|School of Pharmacy and Medical Sciences, Sansom Institute, University of South Australia, Adelaide, Australia. Simon.Bell@unisa.edu.au.|Faculty of Health Sciences, Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. Simon.Bell@unisa.edu.au.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.affiliation: Department of General Practice, University of Helsinki, PO Box 20, 00014, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi.|Unit of Primary Health Care, Helsinki University Central Hospital, PO Box 20, 00014, University of Helsinki, Finland. kaisu.pitkala@helsinki.fi.
authors.forename: Kaisu H
authors.initials: KH
authors.lastname: Pitkala
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D018680:Cholinergic Antagonists / Q000009:adverse effects; D003072:Cognition Disorders / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D009740:Nursing Staff / Q000193:education*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000009:adverse effects
chemical_list: D018680:Cholinergic Antagonists; D011619:Psychotropic Drugs