Falls, Depression and Antidepressants in Later Life: A Large Primary Care Appraisal

Abstract

BackgroundDepression and falls are common and co-exist for older people. Safe management of each of these conditions is important to quality of life.MethodsA cross-sectional survey was used to examine medication use associated with injurious and non-injurious falls in 21,900 community-dwelling adults, aged 60 years or over from 383 Australian general practices recruited for the DEPS-GP Project. Falls and injury from falls, medication use, depressive symptoms (Primary Health Questionnaire (PHQ-9)), clinical morbidity, suicidal ideation and intent, health status (SF-12 Health Survey), demographic and lifestyle information was reported in a standardised survey.FindingsRespondents were 71.8 years (sd 7.7) of age and 58.4% were women. 24% 11% and 8% reported falls, fall related injury, and sought medical attention respectively. Antidepressant use (odds ratio, OR: 1.46; 95% confidence interval, 95%CI: 1.25, 1.70), questionable depression (5–14 on PHQ OR: 1.32, 95%CI: 1.13, 1.53) and clinically significant symptoms of depression (15 or more on PHQ OR: 1.70, 95%CI: 1.14, 1.50) were independently associated with multiple falls. SSRI use was associated with the highest risk of multiple falls (OR: 1.66, 95%CI: 1.36, 2.02) amongst all psychotropic medications. Similar associations were observed for injurious falls. Over 60% of those with four accumulated risk factors had multiple falls in the previous year (OR: 3.40, 95%CI: 1.79, 6.45); adjusted for other demographic and health factors.InterpretationAntidepressant use (particularly SSRIs) was strongly associated with falls regardless of presence of depressive symptoms. Strategies to prevent falls should become a routine part of the management of older people with depression.

Association of psychotropic drug use with falls among older adults in Germany. Results of the German Health Interview and Examination Survey for Adults 2008 – 2011 (DEGS1)

“…In this analysis, antidepressants are indicated to treat depression, which itself, has been recognized as a key independent risk factor for falls [52][53][54]. Yet, there are also studies suggesting that antidepressant use (particularly SSRIs) is strongly associated with falls regardless of the presence of depressive symptoms [44].…”

Antidepressants are Independently Associated with Gait Deficits in Single and Dual Task Conditions

“…Dual task gait deficits predict falls (20), and are important as this task represents the complex but more realistic challenges encountered in daily life. Several studies have linked anti-depressant use to an increased risk of falls, fractures and frailty (5,17,29). Gait deficits associated with anti-depressant use could potentially mediate this relationship, and the paucity of current research highlights the need to examine this further.…”

“…Major depressive disorder is also common, affecting about 3% of community-dwelling older adults in the past year (2) while about 9% experience clinically relevant depressive symptoms (3). Depressive symptoms have been associated with an increased fall risk (4,5) and fallers with high depression scores are twice as likely to report a decline in functional status, social or physical activities as a direct consequence of the fall (6). Iaboni et al (7) present a model describing the complex and bidirectional relationship between depression and falls which includes common risk factors, factors relating to depression and the anti-depressant based treatment of depression, consequences of falls and subsequent effects on mood.…”

“…However, the few studies that adjusted for confounders such as socio-demographics, cognitive function and health (10,11,13) found that independent effects were limited to reduced gait speed and stride length and increased swing time variability (10,13). Anti-depressants are commonly prescribed to older adults and are associated with an increased fall risk independent of depressive symptoms (5,17). This increased risk may be mediated by gait impairments, however, the effect of anti-depressant use on gait is conflicting and limited to a few studies with sample sizes of less than twenty (9,18,19).…”

What is the evidence of the experience of having a fall across the life course? A qualitative synthesis

“…In response, there is an extensive bio-medical and health related, global literature on falls [6][7][8][9][10][11][12] and fear of falling [13][14][15] among older people. Amongst other findings, this literature indicates that despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low, from 10-50% [16], and attrition high.…”