title: Fall and Fracture Risk in Nursing Home Residents With Moderate-to-Severe Behavioral Symptoms of Alzheimer's Disease and Related Dementias Initiating Antidepressants or Antipsychotics.
abstract: BACKGROUND
  Both antidepressants and antipsychotics are used in older adults with behavioral symptoms of Alzheimer's disease and related dementias. Despite the prevalent use of these agents, little is known about their comparative risks for falls and fractures.
  
  
  METHODS
  Using 2007-2009 Medicare claims data linked to Minimum Data Set 2.0, we identified new users of antidepressants and antipsychotics among nursing home residents with Alzheimer's disease and related dementias who had moderate-to-severe behavioral symptoms. Separate discrete-time survival models were used to estimate risks of falls, fractures, and a composite of both among antidepressant group versus antipsychotic group.
  
  
  RESULTS
  Compared to antipsychotic users, antidepressant users experienced significantly higher risk for fractures (adjusted hazard ratio = 1.35, 95% confidence interval = 1.10-1.66). The overall risk of falls or fractures remained significant in the antidepressant versus antipsychotic group (adjusted hazard ratio = 1.16, 95% confidence interval = 1.02-1.32).
  
  
  CONCLUSIONS
  Antidepressants are associated with higher fall and fracture risk compared to antipsychotics in the management of older adults with Alzheimer's disease and related dementias who experience moderate-to-severe behavioral symptoms. Clinicians need to assess the ongoing risks/benefits of antidepressants for these symptoms especially in light of the increasingly prevalent use of these agents.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.|Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville.
authors.forename: Yu-Jung
authors.initials: YJ
authors.lastname: Wei
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore.
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.affiliation: Department of Behavioral and Community Health, Seton Hall University College of Nursing, South Orange, New Jersey.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Lucas
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore.
authors.forename: Nicole
authors.initials: N
authors.lastname: Brandt
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Alzheimer’s disease and related dementia; Antidepressants; Antipsychotics; Falls; Fractures