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Psychiatric drugs tied to falls in the elderly

By Genevra Pittman

NEW YORK (Reuters Health) - Seniors taking psychiatric drugs may be at extra high risk for falling, new Dutch research suggests.

Of about 400 elderly people in the study, those who took medications including antidepressants and antipsychotics were twice as likely to report having fallen three or more times in the previous year, researchers found.

The new study can't prove that falls were due to the effects of the drugs, themselves, and not to seniors' underlying medical conditions, for example.

But a number of side effects of psychiatric drugs - from changes in thinking and attention to drops in blood pressure - could put elderly people at greater risk for falls, according to Dr. Allen Huang, head of geriatrics at The Ottawa Hospital and the University of Ottawa in Ontario, Canada.

"In my clinical observation, it's usually the first two weeks when people start something new that bad things happen," said Huang, who has studied psychiatric drugs in older adults but wasn't involved in the new research.

Seniors are especially vulnerable to falls, which at their worst can cause hip fractures, head injuries or death.

According to the Centers for Disease Control and Prevention, more than 20,000 U.S. seniors died in 2009 as a result of injuries from falls.

"If possible (psychiatric drugs) should be avoided for elderly patients with other risk factors for falling," Astrid van Strien, of University Medical Center, Utrecht, and colleagues wrote in the journal Maturitas.

Their study included 404 people visiting a geriatric clinic in the Netherlands for a range of reasons, from mental impairment to incontinence. On surveys, 238 of the seniors said they had fallen at least once in the past year.

Among the one-third of participants taking psychiatric drugs, 45 percent had fallen three or more times. That compared to just under 22 percent of those who weren't taking a psychiatric drug and reported frequent falls.

In particular, the researchers found a higher rate of multiple falls among people taking antidepressants, antipsychotics and short-acting benzodiazepines, which include the anxiety drug alprazolam (marketed as Xanax) and the insomnia drug temazepam (Restoril).

That pattern held after van Strien's team took into account any depression or cognitive impairment among the seniors, as well as their exact age, their living situation and how much they typically walked each day.

Seniors and their families should come to each healthcare visit with a list of all medications an elderly person is taking and what each was prescribed to treat, Huang said.

Sometimes, he noted, a person gets put on an antipsychotic for delirium while in the hospital, for example, and ends up staying on it for years for no good reason.

"Many of our old people have multiple (conditions) that need medication to control them or make them feel better. Every time somebody is considering adding something, review everything else they're taking to make sure there is a solid indication for everything they're already on," he advised.

Huang said many different factors may raise the risk of falls and fractures, such as age, osteoporosis or a history of stroke.

"Drugs end up being the thing that you can modify," he said. "We can have an effect to lower the falls risk."

SOURCE: http://bit.ly/VILTL1 Maturitas, online January 25, 2013.

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