Falls are a serious health problem for nursing home residents with dementia, particularly as one-third of all falls in such establishments result in injury. (In this study, the researchers noted an average rate of 3 falls per resident with dementia per year).
Many nursing home residents with dementia also have depression. The type of drug most commonly prescribed for them is a class of antidepressants known as serotonin reuptake inhibitors (SSRIs).
Lead author Carolyn Shanty Sterke, from the Section of Geriatric Medicine at Erasmus University Medical Center in Rotterdam, and colleagues, found the link between use of SSRIs and the risks of injurious falls in this group was present at low doses and rose steadily with increasing doses.
And the risk was even higher if residents were also taking certain other drugs, as Sterke explained in a statement:
"Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills."
She said doctors should be careful about prescribing SSRIs to older people with dementia, even if they only need a low dose.
For the study, Sterke collected data on the daily drug use and daily falls in 248 nursing home residents with dementia for all of 2006 and 2007. The average age of the participants was 82 years.
The drug use data came from a prescription database, and the data on falls and subsequent injuries came from standard incident records.
The results showed that:
- Altogether, the data covered a total of 85,074 person-days, with records showing that antidepressants had been given on 13,729 (16.1%) days, and SSRIs dispensed on 11,105 of them.
- The incident records showed that of the 248 participants, 152 (61.5%) sustained a total of 683 falls.
- This corresponds to a fall rate of 2.9 per person per year.
- 38 residents had a single fall in the two-year period, but 114 fell frequently.
- 220 falls resulted in injury or, in the case of one resident, death.
- 10 of the falls resulted in hip fractures, 11 in other fractures, and 198 incurred grazes, open wounds, sprains, swellings and bruising.
- There was a "significant dose-response relationship between injurious falls and the use of SSRIs".
- The risk of an injurious fall "increased significantly with 31% at 0.25 of the Defined Daily Dose (DDD) of a SSRI, 73% at 0.50 DDD, and 198% [ie threefold] at 1.00 DDD."
- The absolute daily risk for an 80-year-old woman not taking SSRIs was 0.09%.
- For an 80-year-old woman taking one defined daily dose of SSRIs, it was 0.28%.
- There were similar increases in absolute daily risks for both men and women at different ages.
"Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia."
"Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," urged Sterke.