title: Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review.
abstract: A 2012 update of the Beers criteria categorizes selective serotonin reuptake inhibitors (SSRIs) as potentially inappropriate medications in all older adults based on fall risk. The application of these recommendations, not only to frail nursing home residents, but to all older adults, may lead to changes in health policy or clinical practice with harmful consequences. A systematic review of studies on the association between SSRIs and falls in older adults was conducted to examine the evidence for causation. Twenty-six studies met the inclusion criteria. The majority of studies were observational and suggest an association between SSRIs and falls. The direction of the relationship--causation or effect--cannot be discerned from this type of study. Standardized techniques for determining likely causation were then used to see if there was support for the hypothesis that SSRIs lead to falls. This analysis did not suggest causation was likely. There is no Level 1 evidence that SSRIs cause falls. Therefore, changes in the current treatment guidelines or policies on the use of SSRIs in older adults based on fall risk may not be justified at this time given the lack of an established evidence base. Given its significance to public health, well-designed experimental studies are required to address this question definitively.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, PA. Electronic address: gebarama@upmc.edu.
authors.forename: Marie Anne
authors.initials: MA
authors.lastname: Gebara
authors.affiliation: Bernard Becker Medical Library, Washington University, St. Louis, MO.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lipsey
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, PA.
authors.forename: Jordan F
authors.initials: JF
authors.lastname: Karp
authors.affiliation: Department of Psychiatry, Oregon Health and Science University School of Medicine, Portland, OR.
authors.forename: Maureen C
authors.initials: MC
authors.lastname: Nash
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, ON; University Health Network, Toronto, ON.
authors.forename: Andrea
authors.initials: A
authors.lastname: Iaboni
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lenze
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D057970:Inappropriate Prescribing; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: Falls; SSRI; older adults