{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:09:29Z","timestamp":1786975769216,"version":"build-2736575974"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. Previous studies suggesting an increased risk of falls and related injuries (FRI) associated with antidepressant use may be affected by confounding by indication or immortal time bias.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between FRI risk and first-line treatments in older adults with depression.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used a target trial emulation framework with a cloning-censoring-weighting approach with Medicare claims data from 2016 to 2019. Participants included fee-for-service beneficiaries aged 65 years or older with newly diagnosed depression. Data were analyzed from October 1, 2023, to March 31, 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n First-line depression treatments including psychotherapy, sertraline, escitalopram, citalopram, mirtazapine, duloxetine, trazodone, fluoxetine, bupropion, paroxetine, and venlafaxine.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n One-year FRI rate, restricted mean survival time (RMST), and adjusted hazard ratio (aHR) with 95% CI.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 101\u202f953 eligible beneficiaries (mean [SD] age,\u200976 [8] years), 63\u202f344 (62.1%) were female, 7404 (7.3%) were Black individuals, and 81\u202f856 (80.3%) were White individuals. Compared with the untreated group, psychotherapy use was not associated with FRI risk (aHR, 0.94 [95% CI, 0.82-1.17]), while other first-line antidepressants were associated with a decreased FRI risk (aHR ranged from 0.74 [95% CI, 0.59-0.89] for bupropion to 0.83 [95% CI, 0.67-0.98] for escitalopram). The FRI incidence ranged from 63 (95% CI, 53-75) per 1000 person-year for those treated with bupropion to 87 (95% CI, 83-90) per 1000 person-year for those who were untreated. The RMST ranged from 349 (95% CI, 346-350) days for those who were untreated to 353 (95% CI, 350-356) days for those treated with bupropion.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.35535","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T11:32:49Z","timestamp":1724671969000},"page":"e2435535","source":"Crossref","is-referenced-by-count":14,"title":["Injurious Fall Risk Differences Among Older Adults With First-Line Depression Treatments"],"prefix":"10.1001","volume":"7","author":[{"given":"Grace Hsin-Min","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Chia-Cheng","family":"Lai","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amie J.","family":"Goodin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel C.","family":"Reise","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald I.","family":"Shorr","sequence":"additional","affiliation":[{"name":"North Florida\/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, Florida"},{"name":"College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Hsuan","family":"Lo-Ciganic","sequence":"additional","affiliation":[{"name":"North Florida\/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, Florida"},{"name":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pennsylvania"},{"name":"Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"issue":"1","key":"zoi241058r1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12991-021-00375-x","article-title":"Prevalence and determinants of depression among old age: a systematic review and meta-analysis.","volume":"20","author":"Zenebe","year":"2021","journal-title":"Ann Gen Psychiatry"},{"issue":"5","key":"zoi241058r2","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.jagp.2013.01.008","article-title":"The complex interplay of depression and falls in older adults: a clinical review.","volume":"21","author":"Iaboni","year":"2013","journal-title":"Am J Geriatr Psychiatry"},{"issue":"5","key":"zoi241058r3","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1111\/jgs.2013.61.issue-5","article-title":"Depressive symptomatology as a risk factor for falls in older people: systematic review and meta-analysis.","volume":"61","author":"Kvelde","year":"2013","journal-title":"J Am Geriatr Soc"},{"issue":"1","key":"zoi241058r4","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.archger.2014.09.003","article-title":"Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning.","volume":"60","author":"Kvelde","year":"2015","journal-title":"Arch Gerontol Geriatr"},{"issue":"27","key":"zoi241058r6","doi-asserted-by":"publisher","first-page":"875","DOI":"10.15585\/mmwr.mm6927a5","article-title":"Trends in nonfatal falls and fall-related injuries among adults aged =65 years\u2014United States, 2012-2018.","volume":"69","author":"Moreland","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"zoi241058r7","doi-asserted-by":"publisher","first-page":"239","DOI":"10.7326\/M22-2056","article-title":"Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder: a living clinical guideline from the American College of Physicians.","volume":"176","author":"Qaseem","year":"2023","journal-title":"Ann Intern Med"},{"issue":"9356","key":"zoi241058r8","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1016\/S0140-6736(03)12502-0","article-title":"Drugs and falls in later life.","volume":"361","author":"Evans","year":"2003","journal-title":"Lancet"},{"issue":"4","key":"zoi241058r9","first-page":"371","article-title":"Fall-risk-increasing drugs: a systematic review and meta-analysis: II. 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