Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
Br J Clin Pharmacol. 2012 May;73(5):812-20. doi: 10.1111/j.1365-2125.2011.04124.x.
The contribution of selective serotonin re-uptake inhibitors (SSRIs) to injurious fall risk in patients with dementia has not been quantified precisely until now. Our objective was to determine whether a dose-response relationship exists for the use of SSRIs and injurious falls in a population of nursing home residents with dementia.
Daily drug use and daily falls were recorded in 248 nursing home residents with dementia from 1 January 2006 until 1 January 2008. For each resident and for each day of the study period, data on drug use were abstracted from the prescription database, and information on falls and subsequent injuries was retrieved from a standardized incident report system, resulting in a dataset of 85,074 person-days.
We found a significant dose-response relationship between injurious falls and the use of SSRIs. The risk of an injurious fall increased significantly with 31% at 0.25 of the Defined Daily Dose (DDD) of a SSRI, 73% at 0.50 DDD, and 198% at 1.00 DDD (Hazard ratio = 2.98; 95% confidence interval 1.94, 4.57). The risk increased further in combination with a hypnotic or sedative.
Even at low doses, SSRIs are associated with increased risk of an injurious fall in nursing home residents with dementia. Higher doses increase the risk further with a three-fold risk at 1.00 DDD. New treatment protocols might be needed that take into account the dose-response relationship between SSRIs and injurious falls.
直到现在，选择性 5-羟色胺再摄取抑制剂（SSRIs）对痴呆患者伤害性跌倒风险的作用还没有被精确地量化。我们的目的是确定在患有痴呆的养老院居民人群中，SSRIs 的使用与伤害性跌倒之间是否存在剂量-反应关系。
我们对 248 名患有痴呆的养老院居民进行了 2006 年 1 月 1 日至 2008 年 1 月 1 日的每日药物使用和每日跌倒记录。对于每个居民和研究期间的每一天，从处方数据库中提取药物使用数据，并且从标准化事件报告系统中检索跌倒和随后受伤的信息，从而产生了一个包含 85074 人天的数据集。
我们发现伤害性跌倒与 SSRIs 的使用之间存在显著的剂量-反应关系。伤害性跌倒的风险随着 SSRIs 的使用剂量增加而显著增加：使用 0.25 定义日剂量（DDD）的 SSRIs 时风险增加 31%，使用 0.50 DDD 时风险增加 73%，使用 1.00 DDD 时风险增加 198%（危险比=2.98；95%置信区间 1.94，4.57）。与催眠或镇静剂联合使用时，风险进一步增加。
即使在低剂量下，SSRIs 也与痴呆养老院居民伤害性跌倒风险增加相关。更高的剂量进一步增加风险，在 1.00 DDD 时风险增加三倍。可能需要制定新的治疗方案，考虑 SSRIs 和伤害性跌倒之间的剂量-反应关系。
