Serotonin receptor inhibitor is associated with falls independent of frailty in older adults

Sumika M. Lin, Marcus K. Borges, Alaise S.S. de Siqueira, Marina M. Biella, Wilson Jacob-Filho, Matteo Cesari, Richard C.Oude Voshaar, Ivan Aprahamian

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.

Original languageEnglish
JournalAging and Mental Health
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Serotonin Receptors
Depression
Geriatrics
Major Depressive Disorder
Outpatients
Accidental Falls
Independent Living
Depressive Disorder
Cohort Studies
Prospective Studies

Keywords

  • antidepressants
  • Depression
  • falls
  • frailty
  • older adults

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Lin, S. M., Borges, M. K., de Siqueira, A. S. S., Biella, M. M., Jacob-Filho, W., Cesari, M., ... Aprahamian, I. (Accepted/In press). Serotonin receptor inhibitor is associated with falls independent of frailty in older adults. Aging and Mental Health. https://doi.org/10.1080/13607863.2019.1675143

Serotonin receptor inhibitor is associated with falls independent of frailty in older adults. / Lin, Sumika M.; Borges, Marcus K.; de Siqueira, Alaise S.S.; Biella, Marina M.; Jacob-Filho, Wilson; Cesari, Matteo; Voshaar, Richard C.Oude; Aprahamian, Ivan.

In: Aging and Mental Health, 01.01.2019.

Research output: Contribution to journalArticle

Lin, Sumika M. ; Borges, Marcus K. ; de Siqueira, Alaise S.S. ; Biella, Marina M. ; Jacob-Filho, Wilson ; Cesari, Matteo ; Voshaar, Richard C.Oude ; Aprahamian, Ivan. / Serotonin receptor inhibitor is associated with falls independent of frailty in older adults. In: Aging and Mental Health. 2019.
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abstract = "Objectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6{\%}) used a SSRI (82 without remitted depression) and 306 (37.7{\%}) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8{\%} versus 33.7{\%}, p =.004). After 12 months, 179 participants had at least one fall (22.1{\%}). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.",
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AU - Borges, Marcus K.

AU - de Siqueira, Alaise S.S.

AU - Biella, Marina M.

AU - Jacob-Filho, Wilson

AU - Cesari, Matteo

AU - Voshaar, Richard C.Oude

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AB - Objectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.

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