Spain. Falls constitute one of the principal causes of morbidity and mortality in geriatric patients. The most serious consequence is fracture of the neck of the femur (hip fracture). It is calculated that about 30% of people over 65 years of age experience one fall per year, and among those living in old people’s homes, the percentage is about 50%.

Although there can be many reasons for an elderly person to fall (such as level of mobility, neurological state, vision), a recent cohort study including 190 residents in old people’s homes has identified some risk factors: diabetes (probably due to neurological and secondary vascular deterioration), alterations in balance and walking ability, and a history of falls in the previous year. Antidepressants are associated with a two- to three-fold increase in the risk (confidence interval 95%, 1,2-4,4).

Several epidemiological studies have shown that hypnotic sedatives, antidepressants and antipsychotics are the medicines most frequently implicated both with a higher risk of falls and of fractures. Most studies on antidepressants have analysed the risk associated with tricyclic antidepressants or similar products and it has been suggested that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline could be safer in elderly patients with a higher risk of falling.

In a recently published study involving 2,428 residents in old people’s homes, it was observed that patients treated with antidepressants presented a risk twice as high, which increased with the dosage. There was little difference between tricyclic antidepressants and SSRIs. These findings coincide with another recent study involving 8,239 patients with fractures due to falls and nearly 40,000 controls, in which it was noted that in persons of over 65 years the use of antidepressants (tricyclic or SSRIs) was also associated with a two-fold increase in the risk of fracture due to falling.

Although these studies suggest that the use of antidepressants in the elderly doubles the risk of hip fractures due to falls, the use of antidepressants should not be abandoned for this reason, because the consequences of depression can be more serious. Therefore, when considering treating an elderly patient with antidepressants, other risk factors for falls should be identified and appropriate measures recommended, such as the use of canes or other walking aids, periodical eye tests, accompaniment, and exercises to improve mobility and balance.

Reference: Butlletí Groc, Vol. 12, No.2, p.5, marzo-abril 1999.