Depressive symptoms are common in patients suffering from dementia. Because of this, many patients are given anti-depressants, or selective serotonin uptake inhibitors (SSRIs). Research has shown that increased use of SSRIs is associated with an increased amount of falls in the elderly population, however details are still lacking on the exact relationship in the specific population of nursing home residents. A recent study published by the British Journal of Clinical Pharmacology shed light on the issue by looking specifically at the details of the relationship between SSRIs and injurious falls in the nursing home population. The study found that higher doses of SSRIs increase the risk of falls by three-fold. As falls are becoming increasingly common in nursing homes, it is important to understand all the risk factors that contribute to falls.
The study analyzed daily drug use and monitored falls over a two year period for residents who were able to walk independently (with or without a walking aid). All 248 patients studied met the criteria for dementia. To emphasize the huge effect drugs had on the rate of falls, the study cited one example from one of the patients they studied. An 85 year old female resident, who was on no SSRIs, hypnotics, or sedatives, had a risk of an injurious fall (per day) of 0.12%. After placing her on a dosage of SSRIs, her risk of an injurious fall (per day) jumped up to 31%. What is even more shocking is that her dosage was only 0.25DDD (Defined Daily Dose), whereas the average dosage given to nursing home residents is 1.00DDD. This means that the risk of an injurious fall increases by 198% when you place a patient on SSRIs or other various forms of drugs.
The study also points out the dangerous cycle of drugs and falls. Many nursing homes argue that drugs not only alleviate symptoms but also prevent falls when in fact the opposite is true. Behavioral disturbances like agitation and aggressive behavior (for which SSRIs are often recommended) often lead to an increased fall risk, which in turn lead to a higher drug dosage. Also, increased dosage of SSRIs has not even been shown to be more effective on depressive symptoms. In fact, there is very weak support for the idea that SSRIs are an effective treatment for patients with depression and dementia. Due to these reasons, the study urges clinicians and nursing home staff to prescribe SSRIs to their patients with due caution as to not increase the risk factor for falling.
Despite the consequences of SSRIs, the use of SSRIs and other drugs is quite common in nursing homes. In fact, a huge problem nursing homes often have is that many residents are on too many drugs at once. In previous studies, polypharmacy has already proven to be extremely detrimental to patients, but as this study has shown, the use of drugs can also greatly increase the incidence rate of falls. Many studies have offered more effective alternative treatments for dementia symptoms, but these alternative treatments require an adequate amount of staff to carry out the treatment. Unfortunately, many nursing homes are understaffed which is ultimately the reason why polypharmacy and easily avoidable falls occur.
When choosing a nursing home, it is important to ensure that the nursing home has you or your loved one’s best interests in mind. Drugs should not be prescribed due to convenience, and risk factors for falls should be minimized as much as possible. This cannot occur if the facility is understaffed. If you feel that your loved one have been injured due to improper care, or that the medications that your loved one is taking puts him or her at a higher risk of falling, please do not hesitate to contact us today to see how we can help.