Alzheimer’s: Antidepressants Increase Risk of Head and Traumatic Brain Injuries

MedicalResearch.com Interview with:

Heidi Taipale, PhD Pharm Senior Researcher School of Pharmacy, University of Eastern Finland; and Department of Clinical Neuroscience Karolinska Institutet 

Dr. Taipale

Heidi Taipale, PhD Pharm
Senior Researcher
School of Pharmacy, University of Eastern Finland; and
Department of Clinical Neuroscience
Karolinska Institutet 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Antidepressant use among older persons has been associated with an increased risk of falling and fall-related events, such as hip fractures, in previous studies. Our previous study identified risk of hip fractures in antidepressant among persons with Alzheimer’s disease. As falling is the main causal factor for head traumas and traumatic brain injuries among older persons, we hypothesized that antidepressant use could also be associated with these injuries.

We utilized a nationwide cohort of 70,718 persons newly diagnosed with Alzheimer’s disease, identified from the Finnish registers. The risk of head injuries and traumatic brain injuries was compared between persons initiating antidepressant use and comparison persons of the same age, gender and time since they received diagnoses of Alzheimer’s disease but not using antidepressants. We found a 40-percent increased risk of head injuries and 30-percent increased risk of traumatic brain injuries associated with antidepressant use. Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use – during the first 30 days – but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors. Continue reading

Beta Blockers Linked To Increased Risk of Falls

MedicalResearch.com Interview with:
Dr. Nathalie van der Velde

Internist-Geriatrician
Erasmus MC
Rotterdam
The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In older persons, falls are the leading cause of injuries and often an adverse-drug reaction is involved. By lowering medication-related fall risk, loss of quality of life, institutionalization, and death can be prevented. Nevertheless, for optimal medication-withdrawal in clinical practice, better understanding of medication-related fall risk is essential, especially for the group of cardiovascular drugs, as previous studies showed contradictory results. Therefore, the objective of our study was to assess whether specific drug characteristics determine beta-blocker related fall risk, a frequently prescribed cardiovascular drug.

Our study showed that fall risk was increased in users of non-selective beta-blockers. This was not the case for overall use of beta-blockers or other drug characteristics (lipid solubility, intrinsic sympathetic activity and CYP2D enzyme metabolism).

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Default Settings in Electronic Records Can Facilitate Over-Prescribing

MedicalResearch.com Interview with:

Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY

Dr. Jashvant Poeran

Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY

MedicalResearch.com: What is the background for this study?

Response: Falls are an important patient safety issue among elderly patients and may lead to extended hospitalization and patient harm. Particularly important in elderly patients are high risk drugs such as sleep medications which are known to increase fall risk and should be dosed lower in elderly patients.

In this study we looked at patients aged 65 years or older who fell during hospitalization. We found that in 62%, patients had been given at least one high risk medication that was linked to fall risk, within 24 hours before their fall. Interestingly, we found that also a substantial proportion of these medications were given at doses higher than generally recommended for elderly patients.

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Health and Economic Burden of Falls Expected To Surge

MedicalResearch.com Interview with:

Gwen Bergen, PhD Division of Unintentional Injury National Center for Injury Prevention and Control CDC

Dr. Gwen Bergen

Gwen Bergen, PhD
Division of Unintentional Injury
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Older adult falls are the leading cause of injury death and disability for adults aged 65 years and older (older adults). In this study, we analyzed data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey. Our study found that, in 2014, older Americans reported 29 million falls. Almost a quarter of these or 7 million falls required medical treatment or restricted activity for at least one day. Women reported a higher percentage of falls (30%) compared with men (27%). Whites and American Indian/Alaskan Natives (AI/AN) were more likely to fall compared with Blacks and Asian/Pacific Islanders; and AI/AN were more likely to report a fall injury compared with all other racial/ethnic groups. The percentage of older adults who reported a fall varied by state, ranging from 21% in Hawaii to 34% in Arkansas.

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Addition of Virtual Reality To Treadmill Training Reduced Falls in Older Adults

MedicalResearch.com Interview with:

Anat Mirelman, PhD Director- Laboratory of Early Markers of Neurodegeneration (LEMON) Center for the study of Movement , Cognition and Mobility (CMCM) Department of Neurology Tel Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv 64239, Israel

Dr. Anat Mirelman

Anat Mirelman, PhD
Director- Laboratory of Early Markers of Neurodegeneration (LEMON)
Center for the study of Movement , Cognition and Mobility (CMCM)
Department of Neurology
Tel Aviv Sourasky Medical Center
Sackler School of Medicine, Tel Aviv University
Tel Aviv 64239, Israel

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The main aim of this research was to evaluate the efficacy of using a motor cognitive training using virtual reality in reducing fall frequency and fall risk in older adults.

Falls are a leading cause of morbidity and mortality in older adults. The prevalence of falls is huge, with one out of every 3 adults aged 65 years or older will fall at least once per year, with approximately half of these fallers suffering multiple falls in this period . These statistics are even higher in neurodegenerative conditions such as in Parkinson’s disease and in people with cognitive impairments. For example, studies have shown that as much as 80% of people with Parkinson’s disease fall each year. So many older adults are falling.
The consequences of falls are huge.

The most dramatic result is hip fracture. But this is relatively rare. However, even in the absence of a fracture or other injury, falls often lead to fear of falling, social isolation, and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls, more social isolation. In other words, falls often start a vicious cycle, which has many important negative health consequences. Falls are associated with morbidity and mortality and they also have a huge economic impact. In many western countries, 1-2% of healthcare dollars are spent on falls.

For many years, age-associated changes in muscle strength, balance and gait were viewed as the key factors that contribute to the risk of falls. However, more recently, we and others showed that certain aspects of cognition are also critical to safe ambulation. For example people with AD often fall, almost to the same amount as people with PD, highlighting the cognitive component of falls. This makes sense intuitively if we Imagine the cognitive skills we need just to cross a busy intersection. These tasks require executive function, specially, planning, the ability to avoid obstacles, and the ability to perform two or more tasks at the same time.

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Injuries From Falls Cost Medicare Almost As Much As Cancer Treatment

MedicalResearch.com Interview with:

Elizabeth Burns, MPH Health Scientist, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control CDC

Elizabeth Burns MPH

Elizabeth Burns, MPH
Health Scientist, Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: What is the background for this study?

Response: Falls are the leading cause of both fatal and non-fatal injuries among Americans aged 65 and older. In 2000, the direct cost of falls were estimated to be $179 million for fatal falls and $19 billion for non-fatal falls. Fall injuries and deaths are expected to rise as more than 10,000 Americans turn 65 each day. Within the next 15 years, the U. S. population of older Americans is anticipated to increase more than 50%, with the total number of older adults rising to 74 million by 2030.

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Hip Fractures and Falls Increase Years Before Parkinson’s disease Diagnosed

MedicalResearch.com Interview with:

Helena Nyström MD, PhD Candidate Department of Community Medicine and Rehabilitation Umeå University Umeå, Sweden

Helena Nyström

Helena Nyström MD, PhD Candidate
Department of Community Medicine and Rehabilitation
Umeå University
Umeå, Sweden

Medical Research: What is the background for this study?

Response: Parkinson’s disease (PD) has an insidious onset and the prodromal phase, preceding the onset of the characteristic PD symptoms, may last for decades. Most prodromal signs previously reported are of non-motor type, such as sleep and mood disorders. However, recent studies have reported balance problems and an increased risk of accidental injuries in the last 3-5 years before diagnosis of Parkinson’s disease , and in a previous study we found a lower muscle strength at military conscription in men who were diagnosed with  Parkinson’s disease three decades later. In this study, we aimed to investigate if such subtle strength deficits may translate into an increased risk of fall-related injuries.

Medical Research: What are the main findings?

Response: The median study time was 20 years before the diagnosis of  Parkinson’s disease , and during this time more individuals with PD (18%) than controls (11.5%) had at least one fall-related injury. The risk was most increased in the last few years before the diagnosis of  Parkinson’s disease , but a difference between the groups appeared already a decade before the PD diagnosis. The risk of hip fracture was increased during the entire study time of 26 years before the diagnosis of Parkinson’s disease .

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Men Have Small Risk of Falls and Fractures When Starting Prostate Alpha Blockers

Blayne Welk MD Assistant Professor in the Division of Urology The University of Western Ontario

Dr. Welk

MedicalResearch.com Interview with:
Blayne Welk MD
Assistant Professor in the Division of Urology
Department of Surgery, Western University Institute for Clinical Evaluative Sciences
Department of Epidemiology and Biostatistics
Western University, London, Ontario 

Medical Research: What is the background for this study? What are the main findings?

Dr. Welk: Alpha blocker medications are used to treat urinary symptoms in men. They are very commonly prescribed, especially among the elderly. One of the potential side effects of these medications is low blood pressure and fainting. Newer medications are designed to be more specific to the prostate, in order to try and reduce these risks. Previous studies have had conflicting results regard the risk of low blood pressure, and whether this risk translates into clinically relevant complications like serious falls, fractures or head injury.

This study demonstrated that there is a small, but significant increase in the risk of falls, fractures and head injury associated with the initiation of prostate specific alpha blockers. Most men, however have a very low risk of these events to begin with, so the absolute change in their risk is very small. The mechanism of these outcomes is likely mediated through hypotension, which was also diagnosed in the majority of men with a fall or fracture.

Medical Research: What should clinicians and patients take away from your report?

Dr. Welk: Men starting alpha blocker medication for urinary symptoms should be counselled about the potential risk of low blood pressure and fainting. While not dangerous most of the time, these medications can lead to fractures and head injuries, which have serious consequences in the elderly. Avoiding dangerous activities when first starting these medications, and taking the mediation at night time may help avoid these risks.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Welk: Further research could examine the the role of 5 alpha reductase inhibitors (also used for male urinary symptoms) in modulating the risk of falls and fractures in men being treated with alpha blockers.

Citation:

Welk Blayne, McArthur Eric, Fraser Lisa-Ann,Hayward Jade, Dixon Stephanie, Hwang Y Joseph et al. The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study 2015; 351 :h5398

Blayne Welk MD (2015). Men Have Small Risk of Falls and Fractures When Starting Prostate Alpha Blockers

Subtle Infections May Cause Falls In Elderly

Farrin A. Manian, MD, MPH, FACP, FIDSA, FSHEA Inpatient Clinician Educator, Department of Medicine, Massachusetts General Hospital Visiting Associate Professor, Harvard Medical School, Boston, MA 02114MedicalResearch.com Interview with:
Farrin A. Manian, MD, MPH, FACP, FIDSA, FSHEA
Inpatient Clinician Educator,
Department of Medicine,
Massachusetts General Hospital
Visiting Associate Professor, Harvard Medical School
Boston, MA 02114

Medical Research: What is the background for this study? What are the main findings?

Dr. Manian:  Falls are a leading cause of injury and death, afflicting about one-third of adults over 65 years of age annually.  Although there are many potential causes for falls, infections have received very little attention, with previous published reports primarily revolving around institutionalized elderly with dementia and urinary tract infection.

We found that the spectrum of patients at risk for falls precipitated by infections goes far beyond the institutionalized elderly with dementia and urinary tract infection.  In fact, the majority of our patients fell at home and did not have a diagnosis of dementia.  In addition, besides urinary tract infections which accounted for 44.1% of cases, bloodstream (40.0%) and lower respiratory tract infections (23.0%) were also frequently represented.  Although the mean age of our patients was 76 years, 18% were younger than 65 years.  We also found that the signs and symptoms of these infections at the time of the presentation for the fall were often non-specific (e.g. weakness or mental status changes) or absent, with only 44% of patients meeting the criteria for systemic inflammatory response syndrome and only 20% having fever or abnormal temperature possibly related in part to advanced age.  These factors may make it difficult for the patient, family members and healthcare providers to readily consider infections contributing to the fall.  In fact a coexisting systemic infection was not initially suspected by providing clinicians in 40% of our patients and 31% of those who were later diagnosed with a bloodstream infection.
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Exercise May Be More Effective Than Vitamin D In Reducing Falls

MedicalResearch.com Interview with:
Kirsti Uusi-Rasi, PhD, Adjunct Professor
Senior Researcher
UKK Institute for Health Promotion Research
Tampere Finland

Medical Research: What is the background for this study? What are the main findings?

Dr. Kirsti Uusi-Rasi: Falls are the leading cause of unintentional injuries and fractures in
older adults, head injuries and fractures being the most severe
consequences. Therefore, falls prevention is important when trying to
prevent injuries. There is strong high-quality evidence from previous
studies that exercise that includes strength and balance training can
reduce the risk of falling in older adults. However, there are also
studies that have reported no benefit in reducing the actual incidence
of falls. Effects of vitamin D have also been studied widely, and
vitamin D is known to be vital for bone metabolism and health.
However, results regarding effects on falls and fractures are
inconsistent. Furthermore, persons with low vitamin D levels (serum
25OHD) have been associated with lower physical performance and
greater decline in physical functioning, but clinical trials exploring
the role of vitamin D in reducing falls and fractures and in improving
physical functioning are inconclusive. Because there is hardly any
evidence about exercise and vitamin D together, we investigated the
separate and combined effects of multimodal exercise training and
vitamin D supplementation in reducing falls and injurious falls among
older women at risk for falling.

We assigned 409 participants randomly to one of four groups with:
1)vitamin D 800 IU/day and exercise
2) placebo and exercise
3) vitamin D 800 IU/day without exercise
4) placebo without exercise.

Exercise consisted of strength, balance, mobility and agility group training.

At the end of two years, exercise seemed to be more effective in
reducing injurious falls in this age group, with or without vitamin D.
Exercise also improved physical functioning (strength, balance and
mobility). In general, the training program was well tolerated with no
severe adverse effects or injuries. Vitamin D helped maintain femoral
neck BMD and increased trabecular bone density at the tibia. Our study
also suggests that the current vitamin D recommendation (800 IU/d for
older people) is adequate.

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