Nursing home residents taking antidepressant medications are at an increased risk of falling in the days following the start of a new prescription or a dose increase of their current drug, according to a new study by the Institute for Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School.   The side effects of Wellbutrin, Zyban, Effexor and similar drugs increase the risk of nursing home falls.

Published online in the Journal of Gerontology: Medical Sciences, the study found that nursing home residents have a fivefold increased risk of falling within two days of a new prescription for or an increased dose of a non-SSRI (selective serotonin reuptake inhibitor) antidepressant such as bupropion or venlafaxine.   Nursing home staff must closely monitor these residents following a prescription change to prevent potential falls.

To reduce the risk of nursing home falls and other injuries, all facilities are required to have an assessment done when a resident enters the facility. The assessment should describe the functional capacity of the resident and evaluate their risk for falling. Based on this assessment, proper steps must be taken to supervise the resident and provide safety devices to prevent a fall injury.

The study looked at data on 1,181 nursing home residents who suffered falls, and researchers found that nursing home residents were nearly five times as likely to fall within two days of being put on a new non-SSRI antidepressant than those who were not given the drugs. The average age of those who fell was 88 and 71% were female. The effect decreased with time and after five days of being on the antidepressant the risk of falling equaled those of other nursing home residents, researchers found.

Lead author Sarah D. Berry, M.D., M.P.H., a scientist at the Institute for Aging Research, says the risk of falls may be due to acute cognitive or motor effects that have not yet been fully investigated. Certain non-SSRIs, such as trazodone, can cause postural hypotension, a dramatic decrease in blood pressure upon standing that may contribute to falls. Other non-SSRIs, like venlafaxine, can cause sedation and coordination problems that may lead to falls.

According to some estimates, more than one-third of the country’s nearly 1.6 million nursing home residents take some type of antidepressant medication. Several previous studies have implicated antidepressants, including both SSRIs, such as paroxetine and sertraline, and non-SSRIs, as a risk factor for falls, especially among older adults.

Both tricyclic antidepressants and SSRIs, the most commonly prescribed antidepressant medications, have been associated with up to a sixfold increased risk of falls among nursing home residents in other studies. Newer drugs, including serotonin-norepinephrine reuptake inhibitors, may also be associated with falls risk.

In light of her findings, says Dr. Berry, an instructor in medicine at Harvard Medical School, "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 funded by a grant from the National Institute on Aging, the Hartford Geriatrics Health Outcomes Research Scholars Awards Program, and the Men’s Associates of Hebrew SeniorLife.

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making.

Founded in 1903, Hebrew SeniorLife, an affiliate of Harvard Medical School, is a nonprofit, nonsectarian organization devoted to innovative research, health care, education and housing that improves the lives of seniors. For more information, please visit www.hebrewseniorlife.org.

 

 

KCBD out of Lubbock, Texas reported the investigation into the death of Willie Joe Byers who froze to death at the Tumbleweed Nursing Home. Police concluded that Byers died after being outside for several hours in freezing temperatures. He was finally found by a nursing home employee in the outdoor courtyard.  The staff is supposed to check on residents every two hours. The Texas Department of Aging and Disability requires that if a facility accepts a new resident that is reported to have dementia and/or a history of wandering, the resident should be closely monitored.

Deion Mitchell, Byer’s Nephew, said that he "found out about his Uncle’s death from a family friend, who knew someone that works at the facility. We had no idea that he was even transferred to the Tumbleweed Nursing Home."

According to Byer’s nephew, "Surveillance cameras show that Willie walked out of the facilities back courtyard door and apparently fell and hit his head while outside, and was found lying next to a shed."

 

 

Miami Herald had a great article about how new technology is helping elderly people.  New devices monitor how well seniors are managing activities of daily living, aid with some tasks and help avoid any move to a nursing home.  Scientists, doctors, engineers and philosophers  gathered last month at a TEDMED (Technology, Entertainment, Design Medicine) conference to unveil solutions to some health care problems.

One of the devices that has been improved over the last few years is a pendant that can call 911 if the wearer falls.  Now the device can be programmed to answer the phone, reminders to take  medicine or alert to a fire, among other things.   It’s one of several new products designed to help seniors stay in their homes.  At-home technology now can monitor senior citizens’ movements, vital statistics, and sleep and bathroom patterns.  Many older people like having technology provide this extra layer of security because it doesn’t require them to give up privacy.

The monitoring systems, which cost $150 to $200 a month, are more often prescribed to seniors for a limited time after a hospitalization or health issue. Some also are being used in assisted-living facilities where operators like the additional protections they offer.

Technology will allow seniors to avoid “unnecessary early institutionalization” because it will relieve the anxiety of loved ones. The ability to closely monitor a person’s lifestyle also can help family members know when the older person is unable to remain home, said Katie Boyer, director of marketing for Home for Life Solutions, in Lee Summit.

Besides monitoring falls and daily activities, her company sells equipment that will turn off a stove if the user forgets. A built-in motion detector turns the appliance off if the user leaves the room and does not return in a specific time frame. As for managing medicine, systems exist that will dispense it at appropriate times and remind patients to take it. If the patient fails to take the medicine, the pills can move into a locked chamber to avoid an overdose.

GE has two products aimed at seniors: Health Guide allows users to check their blood pressure, sugar levels or heart rate daily. The information is sent to a medical provider who tracks it. If problems arise, the patient can have a teleconference with a nurse or schedule an appointment with their doctor.

The company also offers QuietCare, which uses sensors that learn daily activities and behaviors, and then watches for changes. The sensors will alert help if a person falls, goes to the bathroom at night and doesn’t return to bed, or fails to get out of bed in the morning. Sensors also can be placed near the medicine cabinet or refrigerator, so monitors can track whether the person is taking their medicine and eating.

John Cobb, CEO of Senior Lifestyle, started to install QuietCare in some of his company’s 70 senior living facilities this summer because he thought it would make residents safer. With QuietCare, his staff can keep track of residents’ whereabouts at night, he said.

 

Northwest Arkansas Times had an article about a resident who died only 6 days after getting admitted to a nursing home. She was only 63 years old.  Why did they agree to accept her if they couldn’t take care of her?

Donna Fay Snow dislodged her catheter line, entered the bathroom and fell. She bled to death while lying on the bathroom floor before she was found at 5: 35 a. m.   Many times the resident needs to go to the bathroom and hits the call light/bell but gets no response so they try to go to the bathroom without assistance.  In this case, the call light was not operating properly.

"It appears that the cord to her nursing call light was missing," the lawsuit states.

Snow had a port placement for dialysis in her upper left jugular vein that she was prone to pick, according to the complaint.  The nursing home and its staff knew about Snow’s medical condition and should have taken steps to care for her needs, the lawsuit alleges.