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.

Conclusion: Educating nurses using activating learning methods can reduce the prevalence of harmful medications and the incidence of falls among residents in institutional settings.