Last week, we discussed a recent study that found an association between the use of SSRI’s and an increased risk of falling in patients with dementia. Since SSRI’s are used for depression, let’s look at the connection between depression, dementia and falling.
Depression may increase the risk of falling due to sleep disturbances resulting in daytime drowsiness, and nocturia (nighttime urination). Sleep disturbances associated with depression include insomnia, poor quality sleep and early waking. Nocturia causes increased risk of falling by subjecting the patient to the risky situation of ambulating at night, possibly in the dark. Patients with depression may be more “inner focused” and less aware or concerned about potential fall hazards in their environment.
Cognitive Impairment (Dementia) can result in a patient engaging in risky behaviors and being less aware of their environment. Dementia is associated with impaired judgment, impaired gait, impaired visual-spatial perception, and decreased ability to recognize and avoid hazards. Van Dorn et al report “Nursing home residents with dementia were nearly twice as likely to fall as those without dementia even when other important risk factors were controlled for.” {{1}}[[1]] Van Doorn, C., Gruber-Baldini, A., Zimmerman, S., Hebel, J., Port, C., & Baumgarten, M. (2003). Dementia as a risk factor for falls and fall injuries among nursing home residents. JAGS, 51(9), 1217.[[1]]
