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31-01-2012 | General practice | Article

Antidepressants associated with falls among nursing home residents


Free abstract

MedWire News: Nursing home residents with dementia have a threefold increased risk for an injurious fall if they use serotonin reuptake inhibitors (SSRIs), according to research published in the British Journal of Clinical Pharmacology.

A high proportion of nursing home residents with dementia are treated with antidepressants, with SSRIs being the general treatment of choice, explain study author Tischa van der Cammen (Erasmus University Medical Center, Rotterdam, the Netherlands) and colleagues.

The authors suggest that, in light of their research, new treatment protocols might be worth considering. "Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses," said author Carolyn Sterke, also from the Erasmus University Medical Center, in a press release.

The researchers conducted their study using data on daily drug use and daily falls in 248 nursing home residents recorded over 2 years. The mean age of the study cohort was 82 years.

They found that 152 (61.5%) of the residents sustained a total of 683 falls; 38 of the patients only experienced one fall but the rest fell more frequently. Approximately one-third of the falls resulted in injury, including 10 hip fractures, 11 other fractures, and 198 cases of grazes, open wounds, sprains, bruises, or swellings. One fall resulted in death.

Antidepressant use corresponded to 13,729 person-days, of which 11,105 were attributed to SSRIs.

The researchers calculated that the absolute risk per day for an injurious fall was 0.09% for an 80-year-old female resident not taking an SSRI, but 0.28% for a female resident taking a defined daily dose (DDD) of SSRIs.

They also found a significant dose-response relationship between injurious falls and SSRI use. They say, for example, that compared with nonuse, the fall risk for a woman aged 85 years is increased by 31% at 0.25 the DDD of SSRI, 73% at 0.50 DDD, and 198% at 1.00 DDD. The risk is further increased by 373% if a hypnotic or sedative medication is used in addition to an SSRI.

"Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," said Sterke.

By Chloe McIvor

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