SSRIs increase risk of falls, injuries for elderly patients with dementia

Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are 3 times more likely to have a fall resulting in injury compared with those who don’t use SSRIs, according a study published online January 18 in the British Journal of Clinical Pharmacology.

Even at low doses, SSRIs are associated with an increased risk of a fall resulting in injury and the risk increases with higher doses, according to researchers led by Carolyn S. Sterke, MSc, from Erasmus University Medical Center, Rotterdam, the Netherlands.

SSRIs have been shown to be associated with an increased risk of falling, the authors wrote. “In nursing homes, many patients with dementia are given SSRIs as a treatment for depression. In this group, however, the possible risk of injurious falls by treatment dosage is not known,” they commented.

To determine whether a dose-response relationship exists between the use of SSRIs and falls resulting in injury in nursing home residents with dementia, the researchers recorded daily drug use and falls for 248 nursing home residents with dementia from January 1, 2006, through January 1, 2008.

Drug-use data was abstracted from a prescription database, and information on falls and subsequent injuries was culled from a standardized incident report system.

The data showed that 152 (61.5%) of the residents sustained 683 falls, corresponding to 2.9 falls per person-year. Thirty-eight residents (15.4%) fell only once; however, 114 (46.2%) residents fell frequently. Of the 220 (32.2%) falls that resulted in injury, 21 were fractures, and 198 were Injuries other than fractures (graze, open wound, sprain, bruise, and swelling injuries). One person died.

The risk of having a fall resulting in injury increased significantly, with 31% occurring at 0.25 of the defined daily dose (DDD) of a SSRI, 73% at 0.50 DDD, and 198% at 1.00 DDD (HR=2.98; 95% CI, 1.94-4.57). The risk also increased with age (HR=.05; 95% CI, 1.01-1.09), the use of antipsychotics (HR=1.76; 95% CI, 1.18-2.63), and antidepressants (HR=2.58; 95% CI, 1.57-4.24).

Falls are a major health problem in nursing home residents with dementia. “The results of this study lend support to the consideration that new treatment protocols might be needed that take into account the dose-response relationship between SSRIs and injurious falls,” the authors concluded.