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.

Public Health Relevance

Falls are one of the most serious health concerns in the elderly, and frequently result in disability, injury, institutionalization, and even death. Medication use may be one of the most common and potentially modifiable risk factors for falls in the nursing home. A better understanding of the association between medication changes and falls is likely to lead to the successful development of fall prevention strategies.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
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Joseph, Lyndon
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Hebrew Rehabilitation Center for Aged
United States
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Dore, David D; Zullo, Andrew R; Mor, Vincent et al. (2018) Age, Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents. J Am Med Dir Assoc 19:328-332.e2
Berry, Sarah D; Placide, Sebastian G; Mostofsky, Elizabeth et al. (2016) Antipsychotic and Benzodiazepine Drug Changes Affect Acute Falls Risk Differently in the Nursing Home. J Gerontol A Biol Sci Med Sci 71:273-8
Berry, Sarah D; McLean, Robert R; Hannan, Marian T et al. (2014) Changes in bone mineral density may predict the risk of fracture differently in older adults according to fall history. J Am Geriatr Soc 62:2345-9
Echt, Murray A; Samelson, Elizabeth J; Hannan, Marian T et al. (2013) Psychotropic drug initiation or increased dosage and the acute risk of falls: a prospective cohort study of nursing home residents. BMC Geriatr 13:19
Quach, Lien; Yang, Frances M; Berry, Sarah D et al. (2013) Depression, antidepressants, and falls among community-dwelling elderly people: the MOBILIZE Boston study. J Gerontol A Biol Sci Med Sci 68:1575-81
Berry, Sarah D; Samelson, Elizabeth J; Pencina, Michael J et al. (2013) Repeat bone mineral density screening and prediction of hip and major osteoporotic fracture. JAMA 310:1256-62
Berry, S D; Zhu, Y; Choi, H et al. (2013) Diuretic initiation and the acute risk of hip fracture. Osteoporos Int 24:689-95
Berry, Sarah D; Lee, Yoojin; Cai, Shubing et al. (2013) Nonbenzodiazepine sleep medication use and hip fractures in nursing home residents. JAMA Intern Med 173:754-61
Berry, Sarah D; Ramachandran, Vasan S; Cawthon, Peggy M et al. (2013) Procollagen type III N-terminal peptide (P3NP) and lean mass: a cross-sectional study. J Frailty Aging 2:129-34
Berry, Sarah D; Mittleman, Murray A; Zhang, Yuqing et al. (2012) New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home. Pharmacoepidemiol Drug Saf 21:560-3

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