Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 1;7(8):e2435535.
doi: 10.1001/jamanetworkopen.2024.35535.

Injurious Fall Risk Differences Among Older Adults With First-Line Depression Treatments

Grace Hsin-Min Wang  1 , Edward Chia-Cheng Lai  2 , Amie J Goodin  1 , Rachel C Reise  1 , Ronald I Shorr  3   4 , Wei-Hsuan Lo-Ciganic  3   5   6
Affiliations

Injurious Fall Risk Differences Among Older Adults With First-Line Depression Treatments

Grace Hsin-Min Wang et al. JAMA Netw Open. .

Abstract

Importance: One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. Previous studies suggesting an increased risk of falls and related injuries (FRI) associated with antidepressant use may be affected by confounding by indication or immortal time bias.

Objective: To evaluate the association between FRI risk and first-line treatments in older adults with depression.

Design, setting, and participants: This cohort study used a target trial emulation framework with a cloning-censoring-weighting approach with Medicare claims data from 2016 to 2019. Participants included fee-for-service beneficiaries aged 65 years or older with newly diagnosed depression. Data were analyzed from October 1, 2023, to March 31, 2024.

Exposures: First-line depression treatments including psychotherapy, sertraline, escitalopram, citalopram, mirtazapine, duloxetine, trazodone, fluoxetine, bupropion, paroxetine, and venlafaxine.

Main outcome and measure: One-year FRI rate, restricted mean survival time (RMST), and adjusted hazard ratio (aHR) with 95% CI.

Results: Among 101 953 eligible beneficiaries (mean [SD] age, 76 [8] years), 63 344 (62.1%) were female, 7404 (7.3%) were Black individuals, and 81 856 (80.3%) were White individuals. Compared with the untreated group, psychotherapy use was not associated with FRI risk (aHR, 0.94 [95% CI, 0.82-1.17]), while other first-line antidepressants were associated with a decreased FRI risk (aHR ranged from 0.74 [95% CI, 0.59-0.89] for bupropion to 0.83 [95% CI, 0.67-0.98] for escitalopram). The FRI incidence ranged from 63 (95% CI, 53-75) per 1000 person-year for those treated with bupropion to 87 (95% CI, 83-90) per 1000 person-year for those who were untreated. The RMST ranged from 349 (95% CI, 346-350) days for those who were untreated to 353 (95% CI, 350-356) days for those treated with bupropion.

Conclusions and relevance: In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Shorr reported providing expert testimony on falls that occur in the hospital outside the submitted work. Dr Lo-Ciganic reported receiving grant R21 AG060308 from the National Institute of Aging during the conduct of the study and receiving grants from Merck, Sharp and Dohme, and Bristol Myers Squibb, serving as a consultant for Teva Pharmaceutical, and having a patent pending outside the submitted work. Dr Lai reported receiving funding from Amgen, Novartis, Pfizer, Sanofi, and Takeda outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Relative FRI Rates in the Main Analysis
Falls and related injuries (FRI) was the acute care algorithm, the grace period was 90 days, and follow-up was 365 days.
Figure 2.
Figure 2.. Relative RMST in the Main Analysis
Falls and related injuries (FRI) was the acute care algorithm, the grace period was 90 days, and follow-up was 365 days. RMST indicates restricted mean survival time.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Zenebe Y, Akele B, Necho M. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Ann Gen Psychiatry. 2021;20(1):1-19. doi:10.1186/s12991-021-00375-x - DOI - PMC - PubMed
    1. Iaboni A, Flint AJ. The complex interplay of depression and falls in older adults: a clinical review. Am J Geriatr Psychiatry. 2013;21(5):484-492. doi:10.1016/j.jagp.2013.01.008 - DOI - PMC - PubMed
    1. Kvelde T, McVeigh C, Toson B, et al. . Depressive symptomatology as a risk factor for falls in older people: systematic review and meta-analysis. J Am Geriatr Soc. 2013;61(5):694-706. doi:10.1111/jgs.12209 - DOI - PubMed
    1. Kvelde T, Lord SR, Close JC, et al. . Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning. Arch Gerontol Geriatr. 2015;60(1):190-195. doi:10.1016/j.archger.2014.09.003 - DOI - PubMed
    1. Centers for Disease Control and Prevention . Injury Prevention and Control. Accessed April 18, 2023. https://www.cdc.gov/injury/features/older-adult-falls/index.html

Publication types

Substances