Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community‐Living Older People

Menant, Jasmine C.; Wong, Alfred K. W.; Trollor, Julian N.; Close, Jacqueline C.T.; Lord, Stephen R.

doi:10.1111/jgs.14104

Cited by 29 publications

(34 citation statements)

References 36 publications

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“…26 Depression has been identified as a potential risk factor for TBI, hence our sample may have been enriched for individuals with greater antidepressant use. 27,28 Consistent with this hypothesis, the sample population was majority female and had a high prevalence of Alzheimer's, two factors associated with depression. 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.…”

Section: Discussionsupporting

confidence: 52%

Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury

Albrecht

Mullins

Smith

et al. 2017

The American Journal of Geriatric Psychiatry

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Objectives To characterize psychotropic medication use before and after traumatic brain injury (TBI) hospitalization among older adults. A secondary objective is to determine how receipt of indicated pharmacologic treatment for anxiety and post-traumatic stress disorder (PTSD) differs following TBI. Design Retrospective cohort Setting United States Participants Medicare beneficiaries age ≥65 hospitalized with TBI 2006-2010 with continuous drug coverage for 12 months before and after TBI (n=60,276). Measurements We obtained monthly psychotropic medication use by drug class and specific drugs from Medicare Part D drug event files. International Classification of Disease, 9th Edition CM, codes were used to define anxiety (300.0x) and PTSD (309.81). Results Average monthly prevalence of psychotropic medication use among all patients hospitalized for TBI was 44.8%; antidepressants comprised 73%. Prevalence of psychotropic medication use increased from 2006-2010. Following TBI, psychotropic medication use increased slightly (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.03, 1.06.) Tricyclic antidepressant use decreased post-TBI (OR 0.76; 95% CI 0.73, 0.79) while use of the sedating antidepressants mirtazapine (OR 1.31; 95% CI 1.25, 1.37) and trazadone (OR 1.11; 95% CI 1.06, 1.17) increased. Antipsychotic (OR 1.15; 95% CI 1.12, 1.19) use also increased post-TBI. Beneficiaries newly diagnosed with anxiety (OR 0.42; 95% CI 0.36, 0.48) and/or PTSD (OR 0.39; 95% CI 0.18, 0.84) post-TBI were less likely to receive indicated pharmacologic treatment. Conclusions Older adults hospitalized with TBI have a high prevalence of psychotropic medication use yet are less likely to receive indicated pharmacological treatment for newly diagnosed anxiety and PTSD following TBI.

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Section: Discussionsupporting

confidence: 52%

Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury

Albrecht

Mullins

Smith

et al. 2017

The American Journal of Geriatric Psychiatry

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“…Accordingly, ~90% of patients with AFs and UFs showed SBP values >110 mmHg and one-third of those with syncope showed SBP values <110 mmHg. This finding is consistent with previous reports showing an excess use of antihypertensive drugs in older patients with syncope 30,31,43. However, we found that the number of daily drugs was associated with syncope and UFs with respect to AFs.…”

Section: Discussionsupporting

confidence: 93%

Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

Pasqualetti¹,

Calsolaro²,

Bini³

et al. 2017

CIA

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It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65–105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17–1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27–0.58], 0.40 [0.24–0.68], 0.35 [0.14–0.82], and 0.31 [0.20–0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07–5.90] and 1.24 [1.07–1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50–0.84], 0.52 [0.30–0.89], 0.40 [0.20–0.77], and 0.26 [0.13–0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.

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“…Disorders which are known to cause syncope in the elderly including vaso-vagal syncope and carotid sinus syndrome occur in up to 25% of NAF [8, 9] [10–12]. In addition to shared cardiovascular associations there is a higher reported prevalence of depression in patients with both NAF and syncope[13, 14]. Despite the overlap, falls, NAF and syncope are generally reported separately, therefore studies which distinguish between them and examine them in more depth are required [15].…”

Section: Introductionmentioning

confidence: 99%

Falls, non-accidental falls and syncope in community-dwelling adults aged 50 years and older: Implications for cardiovascular assessment

et al. 2017

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ObjectivesTo calculate the prevalence of all falls, non-accidental falls and syncope in an older population and characterize cardiovascular risk profiles.DesignProspective, longitudinal cohort study.SettingThe first two waves of data from the Irish Longitudinal Study on Ageing (TILDA).Participants8172 community-dwelling adults aged 50 years and older resident in the Republic of IrelandMeasurementsSelf-reported history of all falls, non-accidental falls and syncope in the year preceding the first two waves of data collection. Demographic factors and self-reported cardiovascular conditions were used to characterize cardiovascular risk profiles.ResultsThe prevalence of all falls in the past year was 19.2% or 192 per thousand persons and increased with age (50–64 years 17.5%; 65–74 years 19.4%; 75+ years 24.4%). Non-accidental falls had an estimated prevalence of 5.1% or 51 falls per thousand persons and accounted for 26.5% of all falls reported and also increased with age (50–64 years 4.0%; 65–74 years 5.5%; 75+ years 8.0%). The prevalence for syncope was estimated to be 4.4% or 44per thousand persons but did not show a similar age gradient. Participants with at least 5 cardiovascular conditions were more likely to report all falls (OR = 2.07, 95% CI 1.18–3.64, p<0.05) and NAF (OR = 2.89, 95%CI 1.28–6.52, p<0.05).ConclusionsThe prevalence of all falls and non-accidental falls increases with age but the same pattern was not consistently observed for syncope. There is an increased odds of reporting all three outcomes with increasing number of self-reported cardiovascular conditions. Further work is needed to uncover the interplay between cardiovascular disease and subsequent falls.

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Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community‐Living Older People

Cited by 29 publications

References 36 publications

Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury

Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury

Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

Falls, non-accidental falls and syncope in community-dwelling adults aged 50 years and older: Implications for cardiovascular assessment

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