Falls in nursing home residents receiving pharmacotherapy for anemia

PURPOSE Falls are common among nursing home residents and have potentially severe consequences, including fracture and other trauma. Recent evidence suggests anemia may be independently related to these falls. This study explores the relationship between the use of anemia-related pharmacotherapies and falls among nursing home residents. METHODS Forty nursing homes in the United States provided data for analysis. All incidents of falls over the 6-month post-index follow-up period were used to identify the outcomes of falls (≥1 fall) and recurrent falls (>1 fall). Logistic regression was used to analyze the relationship between falls and recurrent falls with each of the anemia pharmacotherapies after adjusting for potential confounders. RESULTS A total of 632 residents were eligible for analysis. More than half (57%) of residents were identified as anemic (hemoglobin < 12 g/dL females, or <13 g/dL males). Of anemic residents, 50% had been treated with one or more therapies (14% used vitamin B12, 10% folic acid, 38% iron, 0.3% darbepoetin alfa [DARB], and 1.3% epoetin alfa [EPO]). Rates of falls/ recurrent falls were 33%/18% for those receiving vitamin B12, 40%/16% for folic acid, 27%/14% for iron, 38%/8% for DARB, 18%/2% for EPO, and 22%/11% for those receiving no therapy. In the adjusted models, use of EPO or DARB was associated with significantly lower odds of recurrent falls (odds ratio = 0.06; P = 0.001). Other significant covariates included psychoactive medication use, age 75-84 years, age 85+ years, worsened balance score, and chronic kidney disease (P < 0.05 for all). CONCLUSION Only half of the anemic residents were found to be using anemia therapy (vitamin B12, folic acid, or iron). There is little evidence to support an association between the use of vitamin B12, folic acid, or iron in reducing the rates of falls and recurrent falls in nursing homes. Reduced odds of recurrent falls were observed for DARB or EPO users.