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Am J Geriatr Psychiatry. 2015 Oct;23(10):1016-28. doi: 10.1016/j.jagp.2014.11.004. Epub 2014 Nov 25.

Cause or Effect? Selective Serotonin Reuptake Inhibitors and Falls in Older Adults: A Systematic Review.

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Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, PA. Electronic address:
Bernard Becker Medical Library, Washington University, St. Louis, MO.
Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, PA.
Department of Psychiatry, Oregon Health and Science University School of Medicine, Portland, OR.
Department of Psychiatry, University of Toronto, Toronto, ON; University Health Network, Toronto, ON.
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.


A 2012 update of the Beers criteria categorizes selective serotonin reuptake inhibitors (SSRIs) as potentially inappropriate medications in all older adults based on fall risk. The application of these recommendations, not only to frail nursing home residents, but to all older adults, may lead to changes in health policy or clinical practice with harmful consequences. A systematic review of studies on the association between SSRIs and falls in older adults was conducted to examine the evidence for causation. Twenty-six studies met the inclusion criteria. The majority of studies were observational and suggest an association between SSRIs and falls. The direction of the relationship--causation or effect--cannot be discerned from this type of study. Standardized techniques for determining likely causation were then used to see if there was support for the hypothesis that SSRIs lead to falls. This analysis did not suggest causation was likely. There is no Level 1 evidence that SSRIs cause falls. Therefore, changes in the current treatment guidelines or policies on the use of SSRIs in older adults based on fall risk may not be justified at this time given the lack of an established evidence base. Given its significance to public health, well-designed experimental studies are required to address this question definitively.


Falls; SSRI; older adults

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