title: Antidepressant prescriptions: an acute window for falls in the nursing home.
abstract: BACKGROUND
  Although many studies have implicated antidepressants as a risk factor for falls, it is not clear if risk accrues with duration of use or if there are acute risks associated with initiation of the prescription. We conducted a case-crossover study of nursing home residents with a fall to determine the effect of an antidepressant change (defined as the new prescription of an antidepressant or increasing the dose of a previously used antidepressant) on fall risk.
  
  
  METHODS
  Among 1,181 nursing home fallers, we compared the frequency of antidepressant changes during the hazard period (1-7 days before the fall) with the frequency of antidepressant changes during the control period (8-14 days before the fall). Odds ratios were estimated using conditional logistic regression models. Results were estimated for non-selective serotonin reuptake inhibitors (SSRI) and SSRI prescriptions, separately.
  
  
  RESULTS
  Mean age was 88 years, and 71% were females. Seventy participants experienced an antidepressant change during the hazard and/or control periods. The maximum effect of falling occurred within 2 days of a non-SSRI change (odds ratio: 4.7, 95% confidence interval, 1.3-16.2). The effect on falling was no longer significant at 5 days (odds ratio: 1.9, 95% confidence interval, 0.9-4.0). No association was found between SSRI changes and falls.
  
  
  CONCLUSIONS
  Nursing home residents are at high risk of falls during the days following a new prescription or increased dose of a non-SSRI antidepressant. Increased surveillance should occur, particularly during the first 48 hours, in an effort to decrease falls.
authors.affiliation: Hebrew Rehabilitation Center, IFAR, 1200 Centre Street, Boston, MA 02131, USA. sarahberry@hsl.harvard.edu
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Berry
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Kiel
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009735:Nursing Homes; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents