Current Research

Title: Prevention of Injury in Skilled Nursing Facilities through Medication Optimization (PRISM)

Title: Deprescribing of Diabetes Treatment Regimens in Long Term Care Residents with Alzheimer’s Disease and Related Dementias

Title: Evaluating the Effectiveness of an Algorithm to Identify Important Drug-Drug Interactions that Impact Nursing Home Residents

Title: Epidemiology and Long-Term Effect of Cardiometabolic Medication Substitution during Post-acute Care

Principal Investigator: Chanmi Park
Background: Each year over 1 million Medicare beneficiaries are discharged to skilled nursing facilities (SNF) from acute care hospitals. Acute hospital-to-SNF transitional period is susceptible to medication discrepancy–inconsistencies in medication regimens across different care sites. Medication discrepancy can take the form of omission, addition, duplication, and substitution. It may arise from miscommunications, inadequate reconciliation processes, and formulary or financial restrictions in hospitals or SNFs. Limited prior research showed that medication discrepancy occurs up to 50% during hospital-to-SNF transitions and typically involves cardiovascular, neuropsychiatric, and anticoagulant agents. Our clinical experience suggests that newer, brand-name, and costly medications, such as those selected as the top 10 expensive drugs in the Medicare Part D spending (e.g., angiotensin receptor neprilysin inhibitor [ARNI], glucagon-like peptide 1 receptor agonists [GLP-1RA], and sodium-glucose cotransporter 2 inhibitors [SGLT2i], are often substituted with less expensive and less efficacious alternatives. This substitution of medications occurs partly because SNFs reimbursement rate is predetermined by the Centers for Medicare & Medicaid Services (CMS) and this rate may not fully cover the expenses incurred when using expensive drugs. To date a systematic examination has not been possible due to lack of a database containing medication administration records in a large number of SNFs. Critical gaps remain as to what proportion of medication substitution is resolved and how medication substitution affects chronic disease outcomes.
Study design: Observational, retrospective cohort study.
Specific aims & key measures:
Aim 1. To determine the frequency and factors associated with medication substitutions of cardiometabolic medications during post-acute SNF stay among older adults after acute hospitalization.
Aim 2. To examine long-term chronic disease outcomes associated with medication substitution during post-acute SNF stay.
Funding source: NIA 1R03AG08873001 

Title: Effectiveness of Algorithms to Identify Unintentional Medication Use Cascades among Nursing Home Residents (The “Cascades” Project)

Principal Investigator: Kaley Hayes/Andrew Zullo
Background: Nursing home (NH) residents need multiple medications for the multiple chronic conditions that they have. Medication use cascades are key drivers of unintentional polypharmacy. A medication use cascade occurs when a new medication is started to treat a side effect from an existing medication. The cascade results in the addition of another medication to manage symptoms, but the cause of the side effect, the original medication, remains. Medication use cascades can occur frequently in the routine clinical care of frail older adults due to their clinical complexity and the common occurrence of new chronic conditions, especially for residents living with Alzheimer’s disease and related dementias (ADRD). There is a critical gap in knowledge regarding the degree of new medication use that results from side effects of existing medications among NH residents. To inform medical providers, consultant pharmacists and long-term care clinicians when additional medications may be the result of medication cascade and could be avoided as well as to reduce provider burden, it is essential to identify true medication use cascades among NH residents.
Study design: Observational, retrospective cohort study.
Specific aims & key measures:
1. Develop algorithms to identify medication use cascades among NH residents, including those with ADRD; and 2. Evaluate the effectiveness of the medication use cascades algorithms using real-world data from the Long-Term Care Data Cooperative by examining whether health outcomes differ between residents with versus without cascades. 

We will compare the outcomes of residents who experience what appears to be a potential medication use cascade (based upon the electronic medication administration record) versus residents who receive only the first of the two medications or medication classes involved in the potential cascade (i.e., individuals without a potential cascade who have the first medication that could have resulted in the cascade, but who did not receive the second medication that represents the occurrence of a cascade). We will look at an array of outcomes, from changes in physical function to fall-related injuries and hospitalizations. We also will examine whether the effects of cascades differ for certain subpopulations who are at higher risk of side effects (e.g., residents with ADRD). To examine the cascades detection algorithm among residents with ADRD, we will classify residents as having ADRD or not using a combination of Medicare Claims, Minimum Data Set, and electronic health record (EHR) information on cognitive function.
Funding source: NIA 1RF1AG08954101 

Title: Post-Acute Care Medication Use and Functional Recovery in Heart Failure

Principal Investigator: Andrew Zullo / Parag Goyal
Background: After hospitalization for heart failure, many older adults are discharged to skilled nursing facilities (SNFs) to recover and regain independence. However, regaining function and returning home can be especially difficult for individuals with heart failure, partly due to the complex role medications play in recovery. Some medications may promote functional improvement, while others may hinder it. This study seeks to identify which commonly used medications are associated with better functional outcomes and higher likelihood of returning home after SNF care.
Study design: Observational, retrospective cohort study.
Specific aims & key measures:
The study will assess the effects of medication use on outcomes such as physical function, discharge to home, hospital readmission, and mortality. Additional outcomes include participation in rehabilitation and cognitive function during the SNF stay. Findings will help inform more effective medication management to support recovery and safe transitions back to the community.
Funding source: NIA - 1R01AG088522-01

Title: Benefits and Harms of Long-term Osteoporosis Pharmacotherapy: Impact of Treatment Length, Type, Switching, and Holidays

Principal Investigator: Kaley Hayes
Background: More than 90% of female and 70% of male nursing home (NH) residents are affected by osteoporosis. NH residents are at high risk of osteoporotic fractures due to advanced age, high fall risk, multiple comorbidities, use of multiple medications, and impaired physical and cognitive function; and thus indicated for osteoporosis treatment. However, many NH residents are often burdened with multiple other chronic medications and have limited life expectancies, potentially reducing the benefits of osteoporosis treatment. Oral bisphosphonates (i.e., alendronate, risedronate, ibandronate) are first-line therapy for osteoporosis and the most prescribed treatment for osteoporosis. Their effectiveness in reducing incidence of vertebral and nonvertebral osteoporotic fractures has been shown in community-dwelling older adults but not in older adults residing in the NH setting, especially after a baseline period of use. Drug holidays, defined as a temporary discontinuation after an initial BP treatment period, are recommended for some patients to reduce the risk of adverse events associated with long-term bisphosphonate treatment, such as atypical femoral fractures and osteonecrosis of the jaw. There is a critical gap in knowledge regarding the use and effectiveness of long-term osteoporosis medication therapy and drug holidays, in NH residents. Most studies have been among older adults residing in the community who have different risk-benefit profiles than NH residents. It is essential to provide evidence on the effects of long-term osteoporosis treatment strategies that will improve clinical decision making for this vulnerable population. Examining the incidence of fractures and other adverse events among patients with varying risk of fractures during drug holidays can inform who will benefit from BPs. Patients who experience fractures during drug holidays may benefit from continuing BP therapy rather than pausing it.

Study design: Observational, retrospective cohort study.

Specific aims & key measures:
Based on EHR and claims data from residents in nursing homes, we will directly compare the outcomes of residents who continue bisphosphonate treatment, switch to another osteoporosis therapy (based upon the electronic medication administration records and claims), or start a drug holiday (i.e., at least 120 days without bisphosphonate use). We will examine multiple clinical outcomes including fractures and other adverse events (e.g., mortality, hospitalization). We will examine effects in clinically important subgroups (e.g., those with prior fracture). We will then formulate a model to predict fractures after bisphosphonate discontinuation using data from multiple sources, including Medicare claims, Minimum Data Set (MDS), and electronic health records (EHR), which provide information on comorbidities and cognitive function. The algorithm will be designed to use the smallest number of clinical inputs possible to aid NH clinicians in deciding whether to stop bisphosphonate therapy (i.e., initiate a drug holiday) vs. continue treatment. We will then identify a threshold to classify residents as either at high or low risk of fracture during a drug holiday to aid in clinical decision-making.
Funding source: NIA- 5R01AG078759-03

Title: Effectiveness of Stopping Antipsychotic Medication among Individuals Admitted to Nursing Home Facilities

Principal Investigator: Mir M. Ali
Background: Antipsychotic medications are used to treat schizophrenia and other psychotic disorders. Additionally, they may be used as adjunct therapy in mood disorders including bipolar disorder and major depression under certain indications. The benefits of antipsychotic medications can sometimes be outweighed by their side effects and health risks, which can vary from mild to severe. Appropriate assessment for gradual dose reduction and deprescribing are key components of safe prescribing of these medications. It is unclear how many nursing home residents are prescribed antipsychotics prior to nursing home admission, and how frequently these medications are later discontinued. For this observational comparative effectiveness study, we will be using the Long-Term Care Data Collaborative Data linked with CMS Medicare claims data. The objective of this study is to compare outcomes among nursing home residents with a) pre-existing prescription to antipsychotic medication and b) those without a prescription, prior to admission. We will examine the frequency of nursing home clinicians de-prescribing antipsychotic medications for patients after 90 days among both groups to assess potential health benefits and risks of stopping these medications.
Study design: Observational comparative effectiveness research.
Specific aims & key measures:
This will be a comparative cohort study design comparing clinical outcomes in nursing home residents that were exposed to and not exposed to antipsychotics prior to admission (with or without a psychotic condition). To understand de-prescribing frequency, we will compare clinical outcomes and adverse effects (AEs) for patients who a) stopped taking antipsychotic medications within 90 days and those who b) continued antipsychotic treatment, among both groups. 

We will measure characteristics of patients and compare AEs among residents with and without a pre-existing prescription. To evaluate the health consequences of deprescribing antipsychotic medication in nursing home residents, we will evaluate antipsychotic drug associated AEs such as neurological effects, stroke, falls, and functional and cognitive impairment as our outcome measures. We will take into account baseline patient, facility level, and geographic characteristics. To account for baseline differences across populations, we will conduct risk adjustments to standardize the comparison groups.
Funding source: NIA (internal funding) 

Title: The Impact of Institutional Special Needs Plan Enrollment on End-of-Life Outcomes for Older Adults with Dementia

Principal Investigator: Momotazur Rahman
Background: Skilled nursing facility (SNF) residents with dementia have complex care needs and often experience hospitalizations and other aggressive care at the end of life. The last decade has seen significant growth and diversification in Institutional Special Needs Plans (ISNPs), a type of Medicare Advantage plan for long-stay SNF residents that integrates a capitated payment model with a Medicare-approved model of care focused on care coordination and quality improvement. Most ISNPs employ on-site advanced practice clinicians to manage chronic illness, treat acute conditions in-house, lead advance care planning, and support SNF nursing staff. Additionally, financial quality incentives built into the model reward favorable outcomes. Our preliminary work using national Medicare data has shown that, among long-stay residents with dementia at the end-of-life, ISNP enrollees are significantly less likely to be hospitalized, admitted to an intensive care unit, or intubated in the last month of the life, compared to residents not on ISNP. The ISNP model may have been particularly important for SNF residents with dementia during the COVID-19 pandemic due to their significantly increased risk for COVID-19-related death which prioritized the need for goals-of-care discussions, advance directive completion, and treatment-in-place within the SNF setting. The electronic health record (EHR) data available through the Long-Term Care (LTC) Data Cooperative provide a unique opportunity to integrate advance directives into our existing work.
Study design: Observational, retrospective, longitudinal study.
Specific aims & key measures:
Objectives: To examine the association of ISNP enrollment with advance directive completion and end-of-life outcomes among SNF long-stay residents with dementia who died between 2019 and 2023. We will further assess how these relationships vary over time (i.e. before, during, and after the pandemic), and with respect to periods of high community COVID-19 prevalence during the pandemic. 

Outcomes: (1) Advance directive status, measured from EHR orders; (2) End-of-life outcomes, measured from Medicare claims for the last 30 days of life, including: hospitalization, mechanical ventilation, intensive care unit admission, and hospice enrollment 

Other Measures: Resident characteristics including date of death, dementia diagnosis, demographic characteristics, and clinical characteristics (including vaccination status) will be measured using a combination of EHR, Minimum Data Set (MDS) and Medicare data. ISNP enrollment will be measured from Medicare enrollment and Medicare Advantage monthly plan data. Facility characteristics such as bed size and zip code will be obtained from CASPER data. Community COVID-19 prevalence will be measured from the Johns Hopkins Coronavirus Resource Center data which is publicly-available.
Funding source: NIA - 1R01AG08209801A1

Title: Integrating Deep Learning and EHR Data to Predict Psychosis, Survival and Fall Outcomes in Nursing Home Residents with Alzheimer's Disease

Principal Investigator: Lirong Wang
Background: Alzheimer's disease and related dementias (ADRD) are common among NH residents, with ~50% developing psychosis, leading to increased care needs, fall-related fractures, weight loss, and skin breakdown. Evidence on treatment effectiveness in reducing psychosis incidence and preventing adverse outcomes remains limited. Our study seeks to evaluate the impact of different treatments on reducing these risks and improving care strategies for NH residents with ADRD. By identifying effective prevention strategies, our findings help nursing home providers optimize care plans to improve residents' quality of life and mitigate adverse health outcomes, including fall-related fractures, unintended weight loss, and skin breakdown.
Study design: Observational, comparative effectiveness research.
Specific aims & key measures:
Aim 1: We will apply DeepBiomarker, a deep learning model, to screen and identify treatments associated with increased psychosis risk. After screening, we will conduct comparative effectiveness analysis using time-to-event methods (Cox models, clinical trial emulations). ADRD will be defined based on both ICD codes and MDS – item I4200. Psychosis will be defined by ICD codes and MDS –item E0100. These definitions would be applied to all aims. 

Aim 2: Retrospective cohort study using time-to-event analysis (Cox models, DeepSurv) to evaluate 1-and 3-year mortality. The medications assessed in Aim 2 will include those identified in Aim 1 as increasing the risk of psychosis, as well as other commonly prescribed drug classes in ADRD patients. Subgroup analyses will assess differential medication effects in ADRD residents with vs. without psychosis and across characteristics (age, sex, race, ZIP code, facility type, comorbidities, functional status, etc.). Censoring will occur at death or prior to hospice entry. 

Aim 3: Retrospective cohort study evaluating associations between specific medication classes (e.g., antihypertensives, antidiabetics, antipsychotics) and key outcomes -- fall-related fractures, unintended weight loss, skin breakdown and functional decline among NH residents with ADRD. We will then test whether these associations differ between ADRD and psychosis vs. ADRD without psychosis. Time-to-event and mixed-effects models will be applied.
Funding source: NIMH - 2R01MH116046

Title: Benefits and Harms of Antihypertensive Management Strategies for Nursing Home Residents with ADRD

• Aim 1. Characterize HTN treatment strategies (i.e., BP measures and changes to the number and dose of antihypertensive medications over time) among nursing home residents with Alzheimer’s Disease and Related Dementias (ADRD).
• Aim 2. Estimate the benefits and harms of an intensive HTN treatment strategy for nursing home residents with ADRD. 
• Aim 3. Identify optimal HTN treatment strategies for clinically relevant subgroups of older adults in nursing home residents with and without ADRD.

Title: Differences in Advance Directive Completion and End-of-Life Care Outcomes Among Asian Nursing Home Residents Living with Cognitive Impairment

Principal Investigator: Hyosin Kim
Background: The documentation of nursing home (NH) residents’ preferences for life-sustaining care and other medical interventions is critical to ensure resident-centered care, especially for persons living with cognitive impairment. Among NH residents with and without cognitive impairment, advance directives have been shown to be associated with lower rates of hospital transfers, avoidable hospital admissions, and inpatient deaths. To the best of our knowledge, no nationwide studies have focused exclusively on the role of advance directives among NH residents with cognitive impairment, and no studies have examined the prevalence and impact of advance directives on end-of-life outcomes among the rapidly growing population of Asian Americans who receive nursing home care, compared with other racial and ethnic groups.

Asian Americans are less likely to complete advance directives and more likely to receive hospital-based intensive end-of-life care. Despite these patterns, whether advance directives are associated with greater hospice use, fewer hospitalizations and lower rates of hospital death for Asian NH residents remains unknown. This gap is compounded by the severe underrepresentation of Asian NH residents in population-based dementia research. Moreover, disparate Asian ethnic groups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) are typically lumped together in research, masking potentially meaningful differences in advance directive completion and end-of-life care outcomes. Limited data on the NH experiences of this diverse Asian American population hinder efforts to reduce unnecessary care transitions and improve end-of-life care quality for this growing NH population.

To address these gaps, this study will directly examine the relationships between advance directives and outcomes (i.e., hospitalizations including avoidable hospitalizations, emergency department visits, hospice use, and place of death) in Asian and other racial/ethnic groups, as well as within Asian ethnic subgroups. Our findings will provide new insights and actionable information that would inform clinical care, health services, and policy. 

Study Design: This is a retrospective cohort study comparing end-of-life outcomes of NH residents with and without advance directive orders.

Specific aims & key measures:
Key measures: Hospice use in the last 6 months of life; all-cause and potentially avoidable hospitalizations in the last 90 days, 30 days, and 3 days of life; emergency department visits or admission to the intensive care unit in the last 3 days of life; and place of death (i.e., nursing home, hospital, or home/community).

Specific aims:
1. Compare the presence and types of advance directives among Asian and other racial/ethnic NH residents with cognitive impairment and describe their clinical and sociodemographic characteristics based on the presence of advance directives.
2. Test whether the presence of advance directives is associated with decreased hospitalizations and emergency department visits, increased hospice use, and lower rates of hospital deaths among Asian and other racial and ethnic groups with cognitive impairment.
3. Explore variations in these relationships across Asian ethnic subgroups with cognitive impairment.

Title: Comparative Analysis of Physical Therapy Effectiveness in Nursing Home (CAP-NH)

Principal Investigator: Lin-Na Chou
Background: There are approximately 1.3 million nursing home residents in the United States at any given point in time, with 82.1% aged 65 or older. Nearly 80% of these residents had at least one chronic condition, such as Alzheimer's disease, cardiovascular disease, diabetes, arthritis, depression, and anxiety. Nursing homes provide essential care for older adults, including managing chronic conditions, offering rehabilitative therapies, and providing palliative care. Physical therapy is a safe and noninvasive treatment that helps improve mobility and functional ability, which is vital for the physical, mental, and emotional well-being of older adults.
Study Design: We will conduct a comparative effectiveness study utilizing electronic health record data and Medicare claims during 2019 to 2024 from the Long-Term Care Data Cooperative to estimate the effectiveness of physical therapy.
Specific aims & key measures:
1. Evaluate the effectiveness of physical therapy in managing pain and sleep problems among nursing home residents.

2. Evaluate the effectiveness of physical therapy in managing chronic conditions, including changes in blood pressure for residents with hypertension, blood sugar levels for residents with diabetes, and cognitive function for residents with dementia

We will compare the pain and sleep problems, physical function, cognitive function, blood pressure, and blood glucose levels between residents who received physical therapy and those who did not. In a secondary analysis, physical therapy exposure will be categorized into four levels—No, Low, Medium, and High—based on tertiles of weekly total minutes or monthly total visits.

Title: GUIDE-atrial fibrillation: Guiding Anticoagulation Decisions for Atrial Fibrillation in Long-Term Care

Principal Investigator: Darae Ko
Background: Atrial fibrillation is an irregular heartbeat that affects 15% of adults aged 65 and older in the United States. Atrial fibrillation can cause blood clots to form in the heart, which can travel to the brain and cause a stroke. Taking oral anticoagulants, i.e. blood thinners, is critical to prevent strokes in people with atrial fibrillation. Oral anticoagulants are generally safe for healthy older adults. However, when older adults become disabled, the risks (bleeding) and benefits (preventing stroke) of oral anticoagulants need to be reassessed. As such, the risks and benefits of anticoagulation in nursing home residents may be different than in healthier older adults. According to the American Heart Association guidelines (Joglar 2023), the need for oral anticoagulants should be reassessed throughout a person’s life with atrial fibrillation. However, there is little information available to help decide whether to continue, stop, or start oral anticoagulants for nursing home residents with atrial fibrillation. The objective of the project is to assess:

• If nursing home residents who were already taking oral anticoagulants before nursing home admission should continue or stop taking them.
• If nursing home residents who were not taking oral anticoagulants before nursing home admission should start or stay off them.

Title: Measuring Mobility, Mentation, Medication and What Matters in the Electronic Health Record

Principal Investigator: Howard B. Degenholtz
Background: The Age-Friendly Health System framework promotes care designed specifically for older adults through the “4Ms”: Mobility, Mentation, Medication, and What Matters. While this model is increasingly used in hospitals and nursing homes, and is even linked to CMS incentive payments, evidence for the effectiveness of Age-Friendly Health System in nursing homes remains limited. A major challenge is the reliance on the Minimum Data Set as the primary data source for measuring quality of care, which focuses on resident status rather than care processes. The LTC Data Cooperative provides a large-scale data set of nursing home electronic health record (EHR) data that has the potential to support advances in the measurement of “4Ms” care and outcomes. This study will assess the feasibility of measuring the “4Ms” in the EHR and whether they lead to improved quality of care for nursing home residents.
Study Design: Secondary retrospective analysis informed by the Donabedian model.
Specific aims & key measures: The aims of this study are as follows: to develop and validate new indicators from EHR data that reflect daily “4Ms” care; to compare quality outcomes between nursing homes that document “4Ms” care and those that do not; and to evaluate whether facilities with formal Age-Friendly Recognition show higher rates of “4Ms” documentation and better quality of care compared to those without it. “4Ms” care measures include delirium assessments (Mentation), deprescribing practices (Medication), documentation of resident preferences (What Matters), and functional status (Mobility). The analysis will account for how provider characteristics and resident outcomes relate to the “4Ms” EHR indicators using publicly available CMS staffing and facility data. The study population includes all long and short stay residents from nursing homes participating in the LTC Data Cooperative.

Title: Effectiveness of Vaginal Estrogen for Recurrent UTIs in Female US Nursing Home Residents

Principal Investigator: Stephanie Zuo
Background: Women are at increased risk for urinary tract infections (UTIs) compared to men, and older women are at most risk due to dramatic changes in the urogenital epithelium and microbiome after menopause. Within US nursing homes, over 75% of residents are female. It is therefore not surprising that UTIs are a significant public health concern and are the most common infection in nursing homes.

One of the most effective therapies for preventing UTIs in postmenopausal women is vaginal estrogen. Vaginal estrogen therapy comes in creams, tablets, rings, and gels. A previous study in Norway in 2011 found that vaginal estrogen was being used by only 10% of female nursing home residents on medications for UTI prevention. Part of the reason for lack of use may potentially be attributed to limited data on the effectiveness of vaginal estrogen for UTI prevention in the nursing home population.
Study Design:We propose a retrospective, comparative effectiveness study.
Specific aims & key measures: Our aims are as follows:
1. To examine the effect of vaginal estrogen on the frequency of UTIs over the following 12 months after first prescription, compared to the 12 months prior to starting vaginal estrogen in female NH residents aged 60 and older with recurrent UTIs.
2. To compare the effectiveness of vaginal estrogen prescription to other prescription UTI preventative strategies (methenamine hippurate, daily antibiotics) in older, female NH residents in the US with recurrent UTIs.

For the first aim, we will compare UTI frequency (using positive urine culture and urinalysis, as well as new antibiotic prescriptions after an ED visit or hospitalization which includes UTI or urosepsis as a diagnosis code) before and after vaginal estrogen prescription of at least 1 month using lab result data and UTI-related encounters with associated antibiotics. We will control for compliance based on length of vaginal estrogen use, as well as baseline frequency of UTIs. For the second aim, we will compare change in UTI frequency after at least 1 month of vaginal estrogen vs. methenamine hippurate vs daily antibiotics and perform propensity score matching using baseline characteristics to reduce bias from confounding.

Title: The Effect of Bladder Anticholinergics Compared to Beta-3 Agonists on Delirium, Falls, and Fractures in Nursing Home Residents

Principal Investigator: Stephanie Zuo
Background: Overactive bladder is a bladder storage syndrome associated with symptoms of urinary urgency, frequency, and/or urge urinary incontinence. It disproportionately affects older women, with over 45% of women aged 65 and older experiencing overactive bladder.

Beyond behavioral changes, the primary therapy for overactive bladder is pharmacologic. Anticholinergic medications are effective for the management of overactive bladder, but have been associated with an increased risk of dementia, as well as delirium and falls. Newer overactive bladder medications, known as selective beta-3 adrenergic receptor agonists (or beta-3 agonists), may provide a safer alternative for older patients while being equally effective. Beta-3 agonists do not impact cognition and are believed to be safer with regards to fall and fracture risks. However, little is known about the impact of beta-3 agonists in the nursing home population which is at particularly high risk for falls, fractures, and acute cognitive dysfunction (delirium).

To address this knowledge gap, we aim to compare the difference between anticholinergic medications and beta-3 agonists on risk of falls, fractures, and delirium in nursing home residents with overactive bladder.
Study Design: We propose a retrospective, comparative effectiveness study using a target trial emulation design, a method which allows us to mimic a randomized trial using historical data. We will compare the 1-year incidence of falls, fractures, and delirium after at least 1 month (30 days) use of anticholinergic overactive bladder medications versus beta-3 agonists in nursing home residents with overactive bladder.
Specific aims & key measures: We will identify all residents who have a new, filled prescription of an anticholinergic overactive bladder medication or beta-3 agonist for at least 1 month and use propensity score methods (a statistical approach to identify similar residents for comparison in order to create two comparable resident cohorts based on known confounders). The primary outcome of interest is a composite outcome of falls, fractures and delirium within the following year after initial prescription of the medication.