Antidepressants and the Risk of Falls among Nursing Home Residents

Thapa, Purushottam B.; Gideon, Patricia; Cost, Terry W.; Milam, Amanda B.; Ray, Wayne A.

doi:10.1056/nejm199809243391303

Cited by 382 publications

(230 citation statements)

References 38 publications

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“…This method is based on a review of the literature and previous studies on DRPs and adverse drug events in older adults, and has been previously published (Kolanowski et al, 2006). For example, falls are known to occur at a higher rate with benzodiazepine and anti-depressant use (Thapa et al, 1998). Given the retrospective nature of the study, our measures for DRPs are limited in their ability to imply causality and will require further testing in a prospective study.…”

Section: Discussionmentioning

confidence: 99%

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Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

243

188

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The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. Keywordsmedications; healthcare costs; geriatrics; adverse drug events Drug-related problems (DRPs) are prevalent in the older adult population and pose a major patient safety concern. DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al., 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs. The purpose of this study was to examine both the prevalence of potentially inappropriate medication (PIMs) use among community-dwelling older adults and the association between PIMs and health care outcomes.One method promoted to identify high-risk medications is the use of an explicit list of PIMs. PIMs were first devised and publicized by Beers et al. for nursing home residents and subsequently expanded to include older adults in all settings (Beers, 1997). PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al., 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al., 2004), acute care (Onder et al., 2005), and community settings (Zhan et al., 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.The clinical validity of using a list of medications based on expert panel review and explicit criteria has been questioned as being overly simplistic and not including all the common drugs causing problems in older adults (Crownover & Unwin, 2005;Shorr, 2004). Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.The Beers criteria have been revised recently; hence, the current prevalence of PIMs in...

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Section: Discussionmentioning

confidence: 99%

“…Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.…”

mentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

243

188

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“…These data are based on pharmacoepidemiologic studies, which are subject to "confounding by indication," that is confounding by the clinical condition for which the drug is prescribed. Notwithstanding this important caveat, risk of falls has been reported with tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs); 48 other specific antidepressants have not yet been studied. The highest risk of falls appears to be within the first few weeks after initiation of an antidepressant.…”

Section: Antidepressants and Fallsmentioning

confidence: 99%

“…The highest risk of falls appears to be within the first few weeks after initiation of an antidepressant. 48 There is little known about whether there are differences between individual medications in the SSRI class and whether there is a dose effect.…”

Section: Antidepressants and Fallsmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

211

161

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Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

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“…72 Table 5 provides a list of drugs that can contribute to falls. [67][68][69][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88] Pharmacists should pay particular attention to these drugs when they are used in older adults, especially if the older adults have a history of falls. Conditions affecting gait and cognitive function include Parkinson' s disease, dementia with Lewy bodies, lower limb fractures, stroke, arthritis, and Alzheimer's disease.…”

Section: Mobility Falls and Fracturesmentioning

confidence: 99%

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

et al. 2005

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In the United States, older adults have become the fastest growing segment of the population and are expected to double in number to 70 million by 2030. As a whole, older adults have different health care needs than younger patients, and some of these needs should be met by pharmacists. Clinical pharmacy practice affecting older adults occurs in a variety of settings, including community, ambulatory care, primary care, hospital, assisted living, nursing home, home health care, hospice, and Alzheimer's disease units. Although specialty training in geriatrics or gerontology is not required for pharmacists to care for older adults, it is extremely helpful. Pharmacy education related to the care of older adults has improved slightly in the past several years but will need to increase even more to provide all pharmacists with the basic skills and knowledge to care for this unique group of patients. In addition, pharmacotherapy research targeting older adults needs to increase. Although it can be challenging, funding for this type of research is available. Patient and political advocacy is also important to support this growing population.

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Antidepressants and the Risk of Falls among Nursing Home Residents

Cited by 382 publications

References 38 publications

Health outcomes associated with potentially inappropriate medication use in older adults

Health outcomes associated with potentially inappropriate medication use in older adults

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

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