Morse Fall Scale Score Impact on Administration of Benzodiazepines and Opioids Público

Abstract

Falls for geriatric populations are a leading cause of death, injury, and have a high economic burden. The toll of falls on patients and hospitals is high, which has led to a significant effort to reduce the rising rate and impact of falls. Prevention of falls starts with using fall assessment measures and incorporating nursing to de-silo data in order to build treatment plans, allocate resources, and target patients at the highest risk. The Morse Fall Scale (MFS) is commonly utilized in clinical care as an assessment tool for fall risk. Data collected from the MFS can then be used in making healthcare decisions and exists for the purpose of informing care providers of fall risk levels for patients. A key area of use for the Morse Fall Scale is potentially in determining how much and which medications to prescribe patients in the context of fall risk. Several pharmacotherapeutic agents have been identified as modifiable risk factors for falls. Benzodiazepines and opioids are two classes of drugs linked to increasing the likelihood for a patient to fall. Thus, patients that have high MFS scores and are at high risk of falling should not be prescribed benzodiazepines or opioids as frequently. In this paper, the likelihood of prescribing benzodiazepines and opioids is evaluated based on the Morse Fall Scale. The Logit model is used to determine average partial effects of the Morse Fall Scale on prescription. Preliminary findings from the data suggest that the opposite of what medical guidance would expect occurs, with patients that have higher MFS scores being more likely to be administered both benzodiazepines and opioids. Initial results highlight that the Morse Fall Scale and fall risk assessment measures may be underutilizing in altering modifiable risk factors for falls.

Table of Contents

Table of Contents

Background Information .................................................................................................................1

1.1 The Impact of Falls .............................................................................................................................................. 1

1.2 Morse Fall Scale .................................................................................................................................................. 1

Table 1.2.1 Morse Fall Scale Form Example ........................................................................................................ 2

1.3 Benzodiazepines Linked to Falls ......................................................................................................................... 4

1.4 Opioids Linked to Falls........................................................................................................................................ 4

1.5 Assessment and Prevention ................................................................................................................................. 4

1.6 Research Questions .............................................................................................................................................. 5

Project Data Overview ....................................................................................................................5

2.1 Project NeLL Overview: About the Project ........................................................................................................ 5

2.2 Project NeLL Overview: About the Data ............................................................................................................ 6

2.3 Classification ....................................................................................................................................................... 6

Methodology....................................................................................................................................7

3.1 Query Method for Patients That Fell ................................................................................................................... 7

3.2 Query Method for Hypertension (Did Not Fall) Patients .................................................................................... 8

3.3 Selection of Years................................................................................................................................................9

3.4 Selection of Age Group ....................................................................................................................................... 9

3.5 Logit Model ....................................................................................................................................................... 10

Patient Demographics....................................................................................................................11

4.1 All Patients Age, Gender, and Race .................................................................................................................. 11

Table 4.1.1 Demographics (Age, Gender, Race) for All Patients ....................................................................... 11

4.2 Patients That Fell Age, Gender, and Race ......................................................................................................... 12

Table 4.2.1 Demographics (Age, Gender, Race) for Patients That Fell.............................................................. 12

4.3 Patients with Hypertension (Did Not Fall) Age, Gender, and Race .................................................................. 13

Table 4.3.1 Demographics (Age, Gender, Race) for Hypertension Patients....................................................... 13

Morse Fall Scale Distributions ......................................................................................................14

5.1 All Patients Morse Fall Scale Information ........................................................................................................ 14

Table 5.1.1 Morse Fall Scale Score Distribution for All Patients ....................................................................... 14

Histogram 5.1.2 MFS for All Patients................................................................................................................. 14

Histogram 5.1.3 MFS for All Patients from Age 50 to 60 .................................................................................. 15

Histogram 5.1.4 MFS for All Patients from Age 60 to 70 .................................................................................. 15

Histogram 5.1.5 MFS for All Patients from Age 70 to 80 .................................................................................. 16

Histogram 5.1.6 MFS for All Patients from Age 80+ ......................................................................................... 16

5.2 Patients That Fell Morse Fall Scale Information ............................................................................................... 17

Table 5.2.1 Morse Fall Scale Score Distribution for Patients That Fell.............................................................. 17

Histogram 5.2.2 MFS for Patients That Fell ....................................................................................................... 17

Histogram 5.2.3 MFS for Patients That Fell from Age 50 to 60......................................................................... 18

Histogram 5.2.4 MFS for Patients That Fell from Age 60 to 70......................................................................... 18

Histogram 5.2.5 MFS for Patients That Fell from Age 70 to 80 ............................................................................. 19

Histogram 5.2.6 MFS for Patients That Fell from Age 80+................................................................................ 19

5.3 Patients with Hypertension (Did Not Fall) Morse Fall Scale Information ........................................................ 20

Table 5.3 Morse Fall Scale Score Distribution for Hypertension Patients.......................................................... 20

Histogram 5.3.2 MFS for Patients with Hypertension ........................................................................................ 20

Histogram 5.3.3 MFS for Patients with Hypertension from Age 50 to 60.......................................................... 21

Histogram 5.3.4 MFS for Patients with Hypertension from Age 60 to 70.......................................................... 21

Histogram 5.3.5 MFS for Patients with Hypertension from Age 70 to 80.......................................................... 22

Histogram 5.3.6 MFS for Patients with Hypertension from Age 80+ ................................................................ 22

Benzodiazepines and Opioids........................................................................................................23

6.1 Overview Logit Model....................................................................................................................................... 23

6.2 Medications........................................................................................................................................................ 23

6.3 Logit Model for All Patients .............................................................................................................................. 23

Logit Model Information 6.3.1 for All Patients .................................................................................................. 24

6.4 Logit Model for Patients That Fell .................................................................................................................... 24

Logit Model Information 6.4.1 for Patients That Fell ......................................................................................... 24

6.5 Logit Model for Hypertension (Did Not Fall) Patients...................................................................................... 24

Logit Model Information 6.5.1 for Hypertension Patients .................................................................................. 25

Benzodiazepines and Opioids Without Midazolam and Without Fentanyl ..................................25

7.1 Overview Logit Model....................................................................................................................................... 25

7.2 Medications........................................................................................................................................................ 25

7.3 Logit Model for All Patients .............................................................................................................................. 26

Logit Model Information 7.3.1 for All Patients .................................................................................................. 26

7.4 Logit Model for Patients That Fell .................................................................................................................... 26

Logit Model Information 7.4.1 for Patients That Fell ......................................................................................... 26

7.5 Logit Model for Hypertension (Did Not Fall) Patients...................................................................................... 27

Logit Model Information 7.5.1 for Hypertension Patients .................................................................................. 27

Benzodiazepines ............................................................................................................................27

8.1 Overview Logit Model....................................................................................................................................... 27

8.2 Medications........................................................................................................................................................ 27

8.3 Logit Model for All Patients .............................................................................................................................. 28

Logit Model Information 8.3.1 for All Patients .................................................................................................. 28

8.4 Logit Model for Patients That Fell .................................................................................................................... 28

Logit Model Information 8.4.1 for Patients That Fell ......................................................................................... 28

8.5 Logit Model for Hypertension(Did Not Fall) Patients....................................................................................... 29

Logit Model Information 8.5.1 for All Patients .................................................................................................. 29

Benzodiazepines Without Midazolam...........................................................................................29

9.1 Overview Logit Model....................................................................................................................................... 29

9.2 Medications........................................................................................................................................................ 29

9.3 Logit Model for All Patients .............................................................................................................................. 30

Logit Model Information 9.3.1 for All Patients .................................................................................................. 30

9.4 Logit Model for Patients That Fell .................................................................................................................... 30

Logit Model Information 9.4.1 for Patients That Fell ......................................................................................... 30

9.5 Logit Model for Hypertension (Did Not Fall) Patients...................................................................................... 31

Logit Model Information 9.5.1 for Hypertension Patients .................................................................................. 31

Opioids ..........................................................................................................................................31

10.1 Overview Logit Model..................................................................................................................................... 31

10.2 Medications...................................................................................................................................................... 32

10.3 Logit Model for All Patients ............................................................................................................................ 32

Logit Model Information 10.3.1 for All Patients ................................................................................................ 32

10.4 Logit Model for Patients That Fell .................................................................................................................. 32

Logit Model Information 10.4.1 for Patients That Fell ....................................................................................... 33

10.5 Logit Model for Hypertension (Did Not Fall) Patients.................................................................................... 33

Logit Model Information 10.5.1 for Hypertension Patients ................................................................................ 33

Opioids Without Fentanyl .............................................................................................................33

11.1 Overview Logit Model..................................................................................................................................... 33

11.2 Medications...................................................................................................................................................... 34

11.3 Logit Model for All Patients ............................................................................................................................ 34

Logit Model Information 11.3.1 for All Patients ................................................................................................ 34

11.4 Logit Model for Patients That Fell .................................................................................................................. 34

Logit Model Information 11.4.1 for Patients That Fell ....................................................................................... 35

11.5 Logit Model for Hypertension (Did Not Fall) Patients.................................................................................... 35

Logit Model Information 11.5.1 for Hypertension Patients ................................................................................ 35

Potential Race Prescription Implications.......................................................................................35

Summary........................................................................................................................................36

13.1 All Logit Model Information ........................................................................................................................... 36

Table 13.1.1 All Logit Model Information.......................................................................................................... 37

Discussion......................................................................................................................................37

Research Question (1) Revisited.............................................................................................................................. 37

Research Question (2) Revisited.............................................................................................................................. 37

Research Question (3) Revisited.............................................................................................................................. 38

Benzodiazepines for Patients That Fell Logit Model Findings ............................................................................... 38

Conclusion ............................................................................................................................................................... 39

Limitations.....................................................................................................................................39

15.1 Project NeLL COVID-19 Issues ...................................................................................................................... 39

15.2 Data Constraints............................................................................................................................................... 39

Future Directions ...........................................................................................................................40

16.1 Additional Data ................................................................................................................................................ 40

16.2 Additional Analysis ......................................................................................................................................... 40

Literature Cited..............................................................................................................................41 

About this Honors Thesis

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School	Emory College
Department	Quantitative Science
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Health Care Management Health Sciences, Pharmacology Health Sciences, Aging
Palabra Clave	Morse Fall Scale Project NeLL Geriatric Prevention Risk Hypertension Falls Benzodiazepines Opioids
Committee Chair / Thesis Advisor	Seunghwa Rho, Emory University
Committee Members	Phyllis Wright, Emory University E. Camille Vaughan, Emory University

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