Prescribing Advice for GPs

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SSRIs linked with falls in patients with dementia

The British Journal of Clinical Pharmacology has published the results of a study that aimed to assess the relationship between use of selective serotonin reuptake inhibitors (SSRIs) and injurious falls in nursing home residents with dementia. A press release has also been issued which has raised awareness in the general media (BBC).

This paper reviewed daily drug use and daily falls as recorded in 248 nursing home residents for a two year period starting January 2006. The average age of the study group was 82. This daily data collection results in a 85,074 person-day dataset. 152 residents sustained 683 falls, with 38 individuals falling on one occasion and 114 individuals falling more than once. The fall incidence was 2.9 falls per person per year.

SSRIs were used on a total of 11,105 person-days of the analysis period. A significant association was found between the risk of an injurious fall and increasing age, antidepressant use and antipsychotic use.

Dose-response relationships were also assessed by correcting drug dosage to a proportional "daily defined dose". Daily defined dose is a measure of drug consumption produced by the World Health Organization. Data models for a typical 85 year old female resident showed that, compared with non-use of an SSRI, a 0.25 proportional dose increased the risk of an injurious fall by 31%. A 0.5 proportional dose increased risk by 73% and 1.0 proportional use increased the risk by 198%. This risk increased even further with concomitant use of other sedatives or hypnotics.

The authors note that the study may be limited due to the data coming from a single nursing home establishment and that there were no users of fluoxetine or escitalopram during the study period.

The authors conclude that, "even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia".

Action: Clinicians should be aware of this new research linking SSRIs with falls. It may be prudent to consider the risk of falls and use the lowest effective dose of SSRIs when treating depression in elderly patients with dementia.

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