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Elderly at Higher Risk for Falls After Antidepressant Drug Changes
Written by George Tait
Monday, 25 July 2011 10:56
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McKnight's Long-Term Care News & Assisted Living recently published an article titled Falling Risk for Residents Increases After Antidepressant Changes stating that nursing home residents have a five-fold increased risk of falling in the two days immediately following a change in the dosage of certain antidepressants.  Specifically, non-SSRI (selective serotonin reuptake inhibitors) antidepressants such as Wellbutrin and Effexor, appear to increase the risk of falling.  The article states,

Experts suspect the falls could be related to acute cognitive or motor effects linked with the medications. Non-SSRI antidepressants such as trazodone (Desyrel) can cause postural hypotension — a dramatic decrease in blood pressure when a person goes from sitting to standing — which could also be a factor, the researchers wrote.

The study's lead author, Sarah D. Berry, M.D. found that the risk of falling was much higher within two days of a change in a non-SSRI prescription.  Berry suggests that "nursing home staff should keep a watchful eye on residents in the days following a non-SSRI antidepressant change to prevent falls and clinicians should avoid making changes on weekends or during times when unfamiliar staff is present."

The study was published in The Journals of Gerontology titled Antidepressant Prescriptions: An Acute Window for Falls in the Nursing Home concluding:

Nursing home residents are at high risk of falls during the days following a new prescription or increased dose of a non-SSRI antidepressant. Increased surveillance should occur, particularly during the first 48 hours, in an effort to decrease falls.

Continuity of care is defined by the American Academy of Family Physicians as:

Continuity of care is the process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care.

Continuity of care is a hallmark and primary objective of family medicine and is consistent with quality patient care. The continuity of care inherent in family medicine helps family physicians gain their patients’ confidence and enables family physicians to be more effective patient advocates. It also facilitates the family physician's role as a cost-effective coordinator of the patient's health services by making early recognition of problems possible. Continuity of care is rooted in a long-term patient-physician partnership in which the physician knows the patient’s history from experience and can integrate new information and decisions from a whole-patient perspective efficiently without extensive investigation or record review.

Continuity of care is facilitated by a physician-led, team-based approach to health care. Thus, the American Academy of Family Physicians supports the role of family physicians in providing continuity of care to their patients in all settings, both directly and by coordination of care with other health care professionals.

When physicians make changes to a resident's drug regimen they need to make sure that those changes are made during weekdays.  Changes should be made during weekdays because typically that is when there are more staff in the facility and those staff are most familiar with the resident.  The staff employed over the weekend are often part-time staff that are not as familiar with the resident and are not as keen to notice behavioral changes in the resident.  

When elderly residents are first admitted to nursing homes they are obviously taken out of their own environment and are often confused.  If the resident is at risk for falls already the potential for falls is compounded with changes to their pharmaceutical regimen.  Physicians and staff need first to make these changes during the week and furthermore put into place appropriate and proactive measures to keep the resident safe from harm.  The harm resulting from a fall to the elderly causes them pain and grief.  When an elderly and beloved falls in a nursing home the family also experiences emotional trauma.  The failure of the physician and the facility to properly protect residents sometimes rises to the level of medical malpractice.

We represent people and their families that are harmed as a result of medical malpractice across Utah including the counties and cities of Beaver, Box Elder, Cache, Carbon, Daggett, Davis, Duchesne, Emery, Garfield, Grand, Iron, Juab, Kane, Millard, Morgan, Piute, Rich, Salt Lake, San Juan, Sanpete, Sevier, Summit, Tooele, Uintah, Utah, Wasatch, Washington, Wayne, Weber, American Fork, Beaver, Bountiful, Brigham City, Cedar City, Delta, Draper, Duchesne, Fillmore, Heber, Kamas, Kanab, Kaysville, Layton, Lehi, Logan, Moab, Murray, Nephi, Ogden, Orem, Park City, Price, Provo, Richfield, Riverton, Roy, Salt Lake City, Sandy, South Jordan, St. George, Tooele, Vernal, West Jordan, and West Valley City.

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