Dose–response relationship between selective serotonin re-uptake inhibitors and injurious falls: a study in nursing home residents with dementia
Article first published online: 5 APR 2012
© 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 73, Issue 5, pages 812–820, May 2012
How to Cite
Sterke, C. S., Ziere, G., van Beeck, E. F., Looman, C. W. N. and van der Cammen, T. J. M. (2012), Dose–response relationship between selective serotonin re-uptake inhibitors and injurious falls: a study in nursing home residents with dementia. British Journal of Clinical Pharmacology, 73: 812–820. doi: 10.1111/j.1365-2125.2011.04124.x
- Issue published online: 5 APR 2012
- Article first published online: 5 APR 2012
- Received; 26 February 2011; Accepted; 14 September 2011; Accepted Article Published Online; 18 January 2012
- nursing homes;
- selective serotonin re-uptake inhibitors
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• Patients treated with selective serotonin re-uptake inhibitors (SSRIs) have been shown to have an increased risk of falling. In nursing homes, many patients with dementia are given SSRIs as a treatment for depression. In this group, however, the possible risk of injurious falls by treatment dosage is not known.
WHAT THIS STUDY ADDS
• Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia. The risk increases with higher doses, with a three-fold increased risk at 1.00 Defined Daily Dose. The combination of a SSRI with a hypnotic or sedative increases the risk even further.
The contribution of selective serotonin re-uptake inhibitors (SSRIs) to injurious fall risk in patients with dementia has not been quantified precisely until now. Our objective was to determine whether a dose–response relationship exists for the use of SSRIs and injurious falls in a population of nursing home residents with dementia.
Daily drug use and daily falls were recorded in 248 nursing home residents with dementia from 1 January 2006 until 1 January 2008. For each resident and for each day of the study period, data on drug use were abstracted from the prescription database, and information on falls and subsequent injuries was retrieved from a standardized incident report system, resulting in a dataset of 85 074 person-days.
We found 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% at 1.00 DDD (Hazard ratio = 2.98; 95% confidence interval 1.94, 4.57). The risk increased further in combination with a hypnotic or sedative.
Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia. Higher doses increase the risk further with a three-fold risk at 1.00 DDD. New treatment protocols might be needed that take into account the dose–response relationship between SSRIs and injurious falls.