Antidepressants and the Risk of Falls among Nursing Home Residents

We retrospectively identified an inception cohort of 2428 nursing home residents in Tennessee who were new users of tricyclic antidepressants, selective serotonin-reuptake inhibitors, or trazodone or nonusers of antidepressants

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

2002

Scholarcy highlights

  • Mood disorders are common among nursing home residents and are associated with substantial excess morbidity and mortality. major depression is treatable in frail elderly persons, including nursing home residents, there is concern that commonly used drugs increase the risk of falls and related injuries. Tricyclic and other heterocyclic antidepressants, until recently the predominant therapy among elderly patients, produce psychomotor impairment and orthostasis, which can lead to falls. In epidemiologic studies of long-term care, users of tricyclic antidepressants have increased rates of falls and injuries, with the increase in risk generally ranging from 50 percent to 200 percent
  • The use of tricyclic and other heterocyclic antidepressants is associated with an increased risk of falls
  • The elevated rates of falls persisted through the first 180 days of therapy and beyond. In this large study of nursing home residents, there was little difference in rates of falls between those treated with tricyclic antidepressants and those treated with selective serotonin-reuptake inhibitors
  • The preferential use of the newer antidepressants is unlikely to reduce the higher rate of falls among nursing home residents taking antidepressants
  • There were no significant differences between the users of individual drugs
  • Major depression is treatable in frail elderly persons, including nursing home residents, there is concern that commonly used drugs increase the risk of falls and related injuries

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