Depression And Antidepressants Increase Risk Of Falling In Later Life

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Main Category: Seniors / Aging
Also Included In: Depression;  Arthritis / Rheumatology;  Psychology / Psychiatry
Article Date: 16 Jul 2008 - 0:00 PDT

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Depression And Antidepressants Increase Risk Of Falling In Later Life

Older people have a high risk for falls and the ensuing injuries. This risk, according to an article released on June 17, 2008 in the open-access journal PLoS ONE, is increased by the presence of depression, and increased even more with medication for depression.

Falls are a common problem in seniors, who often have impaired reflexes and strength. As depression is diagnosed, these same patients are often administered medication, including Selective Serotonin Reuptake Inhibitors (SSRIs), which form the most commonly prescribed family of antidepressants.

According to the published article, depression has been previously correlated with falls: "People with depression and those taking antidepressants, especially SSRIs, are 50% more likely to fall than other older people," said lead author and associate professor Ngaire Kerse. He additionally pointed out the importance of falls in caring for the elderly, as they are "very common and risk factors for falls are easy to identify. "

To investigate the relationships between falls, depression, and the administration of antidepressants, a team of New Zealand and Australian researchers studied the GE-DEPS study, which was created to test the effects of education on patterns of management of depression. In it, all general practitioners in Australia asked all of their patients older than 60 years to respond to a survey, of which 21,900 of them complied. Of these, 24% reported at least one fall in the last year, 11% had injured themselves by falling, and 8% needed to subsequently see a doctor. Some symptoms of depression were reported in about one quarter of participants, while 12% were under medication from an antidepressant, and 6% were being administered SSRIs specifically.

When examining the data, a correlation was seen between using any antidepressant and falling, but an even higher risk was seen when subjects were using SSRIs, with a 66% increase in falls. In fact, having any degree of depression was assoicated with a 70% increase in risk to have multiple falls and injury. Other relationships were discovered as well, for instance: ever having thought about suicide, having a stroke, having arthritis, or having more than three medical problems were associated with having more than one fall.  Finally, women were more likely to sustain injury from a fall than men.

These data marks a step forward in understanding the relationship between these variables. "This risk associated with SSRIs has been reported before but not in such a large group of older people living in the community," Kerse said."More than 60% of women aged over 80 with depression and taking an SSRI fell in the last year. This means that falls prevention strategies must
really be thought of when prescribing antidepressants for older people."

This clearly indicates the need to be aware of this risk when managing the health care of seniors: "Falls are important for all older people," Kerse said.  "But in people with depression, falls add to the consequences of depression.  There is an opportunity to offer fall prevention strategies as part of the initial treatment for depression in patients and as part of ongoing treatment."

Some of these strategies are recommended by the researchers, including lower leg strengthening and balance retraining. It might also include home assessment and modification programs to reduce hazards, to ensure appropriate lighting, remove obstacles, and install transfer rails, all of which are fall prevention strategies.

They add that family members need to be a part of this treatment. "We need to increase the awareness among family members on fall prevention," Kerse said.  "More than one-third of patients with depression will fall and the consequences can be disastrous.  Our findings emphasize the need to incorporate fall prevention strategies in stroke services." He concluded: "We need to emphasise fall prevention during treatment of depression in older people."

Falls, Depression and Antidepressants in Later Life: A Large Primary Care Appraisal.
PLoS ONE 3(6): e2423.
doi:10.1371/journal.pone.0002423
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Written by Anna Sophia McKenney
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