Antidepressant Use and Recurrent Falls in Community-Dwelling Older Adults

Abstract

Background Few studies have compared the risk of recurrent falls across various antidepressant agents—using detailed dosage and duration data—among community-dwelling older adults, including those who have a history of a fall/fracture. Objective To examine the association of antidepressant use with recurrent falls, including among those with a history of falls/fractures, in community-dwelling elders. Methods This was a longitudinal analysis of 2948 participants with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Any antidepressant medication use was self-reported at years 1, 2, 3, 5, and 6 and further categorized as (1) selective serotonin reuptake inhibitors (SSRIs), (2) tricyclic antidepressants, and (3) others. Dosage and duration were examined. The outcome was recurrent falls (≥2) in the ensuing 12-month period following each medication data collection. Results Using multivariable generalized estimating equations models, we observed a 48% greater likelihood of recurrent falls in antidepressant users compared with nonusers (adjusted odds ratio [AOR] = 1.48; 95% CI = 1.12-1.96). Increased likelihood was also found among those taking SSRIs (AOR = 1.62; 95% CI = 1.15-2.28), with short duration of use (AOR = 1.47; 95% CI = 1.04-2.00), and taking moderate dosages (AOR = 1.59; 95% CI = 1.15-2.18), all compared with no antidepressant use. Stratified analysis revealed an increased likelihood among users with a baseline history of falls/fractures compared with nonusers (AOR = 1.83; 95% CI = 1.28-2.63). Conclusion Antidepressant use overall, SSRI use, short duration of use, and moderate dosage were associated with recurrent falls. Those with a history of falls/fractures also had an increased likelihood of recurrent falls.

Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury

“…29-31 Additionally, there is some evidence of an association between SSRIs and increased risk of falls and fractures, suggesting that we may be observing a risk factor for TBI, although our study did not examine this question. 32,33 …”

“…25 Older adults are more likely to initially consult with a primary care provider for psychological problems and receive a psychiatric diagnosis from a non-specialty setting. 32 However, these providers may not feel comfortable prescribing psychotropic medications following TBI in the absence of evidence based recommendations. 11,12,35 The disparity may also result from the perception that a psychological reaction to trauma is expected and will resolve on its own without treatment.…”

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)

“…Use of antidepressants, particularly SSRIs, has been consistently found to be associated with increased risks of falls and recurrent falls [40][41][42][43]. For example, in a longitudinal analysis of 2948 community-dwelling older adults followed-up for 7 years, antidepressant users, compared with nonusers, were observed to have a 48% greater likelihood of recurrent falls (OR 1.48, 1.12-1.96), particularly those taking SSRIs with an OR of 1.62 (1.15-2.28) [40]. Alike, in a cross-sectional survey including community-dwelling older adults from Australian general practices, antidepressants use was independently associated with multiple falls (OR 1.46, 1.25-1.70).…”

Depression in primary care: part 2—management

“…Several studies have found an association between the use of all antidepressants, particularly SSRIs, and falls and fractures in older adults 99100. An older longitudinal analysis (1997-2004) of 2948 older people living in the community found an adjusted odds ratio of 1.62 (1.15 to 2.28) for SSRIs and 1.48 (1.12 to 1.96) for antidepressants overall 101. However, most evidence to date comes from observational studies; and use of antidepressants and falls are both common in this patient population, so causation cannot be inferred 102…”