Antidepressant Prescriptions: An Acute Window for Falls in the Nursing Home

Abstract

Background. Although many studies have implicated antidepressants as a risk factor for falls, it is not clear if risk accrues with duration of use or if there are acute risks associated with initiation of the prescription. We conducted a case-crossover study of nursing home residents with a fall to determine the effect of an antidepressant change (defined as the new prescription of an antidepressant or increasing the dose of a previously used antidepressant) on fall risk.Methods. Among 1,181 nursing home fallers, we compared the frequency of antidepressant changes during the hazard period (1-7 days before the fall) with the frequency of antidepressant changes during the control period (8-14 days before the fall). Odds ratios were estimated using conditional logistic regression models. Results were estimated for non-selective serotonin reuptake inhibitors (SSRI) and SSRI prescriptions, separately.Results. Mean age was 88 years, and 71% were females. Seventy participants experienced an antidepressant change during the hazard and/or control periods. The maximum effect of falling occurred within 2 days of a non-SSRI change (odds ratio: 4.7, 95% confidence interval, 1.3-16.2). The effect on falling was no longer significant at 5 days (odds ratio: 1.9, 95% confidence interval, 0.9-4.0). No association was found between SSRI changes and falls.Conclusions. Nursing home residents are at high risk of falls during the days following a new prescription or increased dose of a non-SSRI antidepressant. Increased surveillance should occur, particularly during the first 48 hours, in an effort to decrease falls.

Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review

“…(46, 59–65) Only one study was a randomized controlled trial which assessed the treatment of psychotic depression. (61) Although there was no statistically significant increase in the rate of falls with sertraline (compared to placebo), the wide confidence interval of the odds ratio suggest that the study was underpowered, as the authors themselves reported; OR= 1.56 (95% CI: 0.63–3.83).…”

“…(61) Nine studies were retrospective and used healthcare databases (16, 48, 49, 52, 53, 56, 60, 62, 63) while ten were prospective(14, 17, 45–47, 51, 57, 64–66) and one was a case-crossover design. (59) There were five case-control studies,(15, 50, 54, 55, 58) with one(58) that also included a self-controlled case series.…”

“…(57) Six studies were conducted in nursing homes or residential care. (16, 49, 51, 52, 56, 59) In comparison to community dwelling older adults, nursing home residents have a higher rate of falling(51, 67) and mood disorders. (68, 69)…”

“…(16, 49, 51, 52, 56, 59) Fall assessment was more varied for community dwelling subjects. This includes quarterly postcards on which patients documented number of falls,(45, 46) self-report or clinician-determined, which ranged from past week,(52) month,(17) to past year,(53) and was obtained directly from the patient, from medical records(48, 50, 61–63), or fall calendars.…”

Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients

“…54 Berry et al observed that changes in specifically non-SSRI antidepressant prescriptions increased the risk of falls within 2 days (OR 4.7, 95% CI 1.3-16.2), with a subsequent decreased risk of falls over the next 5 days (OR 1.9, 95% CI 0.9-4.0). 55 Increased staff awareness might help to reduce falls during this time, and surveillance should be strengthened particularly during the first 48 hours.…”