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Risk factors for falls
during treatment of late-life depression.
Joo JH,
Lenze EJ, Mulsant BH, Begley AE, Weber EM, Stack JA, Mazumdar S,
Reynolds CF 3rd, Pollock BG.
Intervention Research Center for
Late-Life Mood Disorders, Department of Psychiatry, University of
Pittsburgh School of Medicine, PA, USA.
BACKGROUND: Prior studies
have found that antidepressant medications are associated with an
increased risk of falling in elderly persons. However, little is known
about the prevention of falls during treatment for depression in elderly
persons. This study evaluated the time course and potential risk factors
for falls in a treatment protocol for late-life depression to identify
specific at-risk periods and risk factors for falls in this population.
METHOD: One hundred four subjects aged 69 years and over were treated in
a protocolized manner using paroxetine and interpersonal psychotherapy.
Those who did not respond received augmentation therapy with bupropion,
nortriptyline, or lithium. Subjects were assessed at baseline and weekly
during treatment; demographic and clinical characteristics of those who
experienced a fall during treatment were compared with those who did not
fall. Cox proportional hazards models were used to define risk factors
for falls in univariate and multivariate models. RESULTS: During a mean
of 21 weeks of treatment, 40 subjects (38%) fell. About half (53%) of
the subjects fell during the first 6 weeks of treatment. In the
multivariate model, memory impairment and orthostatic changes in blood
pressure during treatment were risk factors for falling. Additionally,
augmentation with bupropion appeared to be a risk factor for falls in
univariate analysis, but this result is preliminary due to the small
number of subjects who took bupropion. CONCLUSION: Increased monitoring
for falls is warranted during the acute treatment of late-life
depression. When treating such patients, clinicians should be especially
watchful of those with memory impairments or those who develop
orthostatic blood pressure changes; orthostatic blood pressure should be
measured throughout acute treatment. Additionally, augmenting paroxetine
with bupropion may also increase the risk of falls, and this medication
combination should be used with caution in elderly
patients.
PMID: 12416604 [PubMed - indexed for MEDLINE]
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