Adjusting Depression Medications May Reduce Fall Risk in Seniors
by Lynn Hetzler
Simply adjusting the dosage of an older adult’s psychiatric medication may reduce his or her risk of falling, according to a new study.
Interventions for depression can be expensive and time consuming. Merely reducing dosages of antidepressant medications may decrease the risk of falling while still providing effective management of depressive symptoms.
About Falls and Depression Among Older Adults
Falls are an indicator of frailty, immobility, and health impairment in older adults. Diminished function can cause falls, and falls can diminish function by limiting activity and causing injury, loss of mobility, and a fear of falling.
Because of frailty and conditions like osteoporosis, falls can cause serious injury in the elderly. The combined effects of falls and osteoporosis increase the risk for fractures of the hip, forearm, humerus, and pelvis in older adults.
Falls are more common among older adults, according to the National Council on Aging, with about one quarter of all Americans over the age of 65 falling each year. In fact, falls are the number-one cause of nonfatal and fatal injuries in older adults. Falls are also the most common cause of nonfatal trauma-related hospital admissions for people in this age group.
Falls are costly, with the total cost of falls in the U.S. topping $34 billion in 2013. The financial toll for falls among older adults will rise as the population ages. By 2020, the cost for falls may reach $67.7 billion.
Previous research suggests that depression and falls have a significant bidirectional relationship. An excessive fear of falling, which is common among seniors with depression, can actually increase the risk of falls. Conventional wisdom has held that falling increases the risk of depression as seniors struggle with the serious physical and life-altering effects of falling.
Managing depression in older adults is challenging as antidepressants can increase the risk of falling. Furthermore, selective serotonin reuptake inhibitors (SSRIs) commonly prescribed for depression can increase the risk of fractures.
Researchers from the University of Michigan used information from the 2006–2010 Health and Retirement Study data and utilized cross-lagged panel structural equation models to evaluate associations between falls and depressive symptoms among 7,233 community-dwelling adults ages 65 and older. The scientists estimated structural coefficients between falls and depressive symptoms from 2006 to 2008 and 2008 to 2010.
Advancing age is associated with the onset of a number of chronic conditions, activity limitations, and sensory impairment problems that can lead to falls and depressive disorders.
Previous cross-sectional studies show strong relationships between depressive symptoms and subsequent falls. Earlier research has also established an association between fractures and subsequent clinical depression and depressive symptoms.
The results of the study show that even a moderate increase in symptoms of depression among seniors was associated with a 30-percent rise in falls over the two years of the study.
“We’ve pinpointed that we think the relationship between depression and falls involves medication use with important implications for patient safety and fall risk reduction,” said Geoffrey Hoffman, research fellow and assistant professor at the U-M School of Nursing in a press release issued by the University of Michigan. “Many interventions to prevent falls are expensive and time-intensive, but this is a simple and inexpensive matter of encouraging continued use of psychiatric medication while improving monitoring of fall risk and adjusting medication appropriately.”
The researchers used a large sample of subjects and sophisticated methods to detect larger magnitudes of effect in the relationship between falls and depressive symptoms than had researchers in other studies. While the study did not formally measure the effect of medication use on falls, the relationship between depressive symptoms and falls became insignificant when the researchers included the use of psychiatric medications into the study model.
As expected, researchers found that many older adults experienced depressive symptoms prior to a fall but they also discovered that symptoms of depression did not necessarily follow a fall—even up to two years after the fall.
The results highlighted the need to assess the risk of falls for older adults with depressive symptoms.
Certain factors place older adults at higher risk for falls. Risk factors for falls among older adults include:
- Muscle weakness, particularly in the legs
- Poor balance and gait
- Postural hypotension, or blood pressure that falls when the individual rises from a lying or seated position
- Slow reflexes that prevent the individual from recovering from a slip, slide, or imbalance
- Foot problems that cause pain or promote the use of unsafe footwear
- Sensory problems, such as peripheral neuropathy, that leads to tripping and balance problems
- Poor night vision
- Vision problems, such as cataracts and glaucoma, that cause poor depth perception or sight loss
- Confusion, even temporary
- The use of certain medications that cause dizziness, drowsiness, or confusion
- The use of multiple medications, as the more medications a person takes, the more likely he or she is to fall
- An environment that increases the risk for falls, such as loose rugs, clutter, and absence of grab bars in bathrooms and stair railings
Health care providers might assess older patients for depressive symptoms, particularly those patients using psychotropic medications, as part of a broadened approach to preventing falls. Prescribers should pay special attention to weighing the risks and benefits of psychiatric medications, particularly for those patients at high risk of falling. Practitioners should also give particular consideration to properly choosing and calculating dosages for antidepressant medications for older adults.
Clinical guidelines for fall risk assessments and quality improvement indicators for fall prevention should include assessment for clinical depression and use of psychotropic medications.
Older adults can reduce their risk of both symptoms of depression and falls by staying active and avoiding fall risks. Seniors who think they are depressed may talk to a family member or physician. Older people could speak to a doctor or pharmacist if they have questions about medications and risks.
Family members can check in on older relatives who live alone, particularly if the senior member of the family suffers depression or has a high risk of falling. Most falls happen at home.
The study, “Depressive symptomatology and fall risk among community-dwelling older adults,” appeared in the journal Social Science and Medicine.