Nursing home residents with dementia: Antidepressants are associated with increased risk of falling

January 19, 2012

Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are three times more likely to have an injurious fall than similar people who don't use these drugs. The association can be seen in people who use low doses of SSRIs and the risk increases as people take higher doses. The results are published in the British Journal of Clinical Pharmacology.

Many nursing home residents with dementia suffer from depression, and are therefore treated with antidepressants. (SSRIs) are generally considered the treatment of choice. "Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as ," said lead author Carolyn Shanty Sterke, who works in the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, The Netherlands.

Falls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls result in an injury. "Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses," says Sterke.

Sterke carried out this research by recording the daily and daily falls in 248 nursing with from 1 January 2006 until 1 January 2008. Data about the residents' day-by day drug use came from a prescription database, and information on falls and subsequent injuries came from a standardised incident report system. In total, she had collected a dataset of 85,074 person-days.

The mean age of the participants was 82 years, and the prescription records showed that antidepressants had been used on 13,729 (16.1%) days, with SSRIs being used on 11,105 of these days.

The incident reports showed that 152 of the 248 residents (61.5%) sustained 683 falls. This corresponds to a fall incidence of 2.9 falls per person-year. Thirty-eight residents had a single fall, but 114 fell frequently. Two hundred twenty resulted in injury or death. Of these 10 were hip fractures, 11 were other fractures and 198 were injuries such as grazes, open wounds, sprains, bruises, and swellings. One person died after falling.

The risk of having an injurious fall increased threefold for residents taking SSRIs, from an absolute daily risk of 0.09% for a female aged 80 not taking an SSRI, to 0.28% for a female aged 80 taking one defined daily dose of SSRIs. Similar increases in absolute daily risk were found for both men and women, for different ages.

"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," says Sterke.

Explore further: Nursing home residents at heightened risk of falling in the days following

More information: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious falls: A study in Nursing Home Residents with Dementia. Carolyn S Sterke, Gijsbertus Ziere, Ed F. van Beeck, Caspar W. N. Looman & Tischa J. M. van der Cammen. BJCP (2012); DOI: 10.1111/j.1365-2125.2011.04124.x

Related Stories

Nursing home residents at heightened risk of falling in the days following

July 15, 2011
Nursing home residents taking certain antidepressant medications are at an increased risk of falling in the days following the start of a new prescription or a dose increase of their current drug, according to a new study ...

Newer antidepressants not necessarily safest for older people

August 3, 2011
New generation antidepressants, known as selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of several severe adverse outcomes in older people compared with older tricyclic antidepressants ...

Increased risk of bleeding with combined use of SSRIs and antiplatelet therapy after heart attacks

September 26, 2011
Heart attack patients taking selective serotonin reuptake inhibitors (SSRIs) in combination with antiplatelet therapy -- acetylsalicylic acid (ASA), clopidogrel or both (dual antiplatelet therapy) -- are at higher risk of ...

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

High-dose vitamin D doesn't appear to reduce the winter sniffles for children

July 18, 2017
Giving children high doses of vitamin D doesn't appear to reduce the winter sniffles, a new study has found.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

dogbert
1 / 5 (6) Jan 19, 2012
These studies keep coming from Europe, recommending withholding antidepressants from the elderly.

The studies fail to acknowledge that depression is also clinically significant, resulting in poor outcomes if not treated.

The studies also fail to acknowledge that aggressive behaviors may prevent the nursing home from accepting the patient or cause the patient's discharge if medical interventions are denied. Patients with dementia and aggression who stay at home have generally many falls and poor medical outcomes.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.