Does psychiatric polypharmacy increase the risk of falls and fractures in older adults?

Psychiatric polypharmacy is when a person is prescribed two or more psychiatric medications at the same time. It is estimated this affects one in every two older adults who start taking an antidepressant in England.

Previous research has shown that taking multiple medications each day may increase a person’s risk of experiencing their negative effects. With psychiatric medications this includes the risk of falling.

Preventing falls in older adults is important because it reduces the risk of fractures and hospitalisations. Falls are also estimated to cost more than £2.3 billion per year in the UK.

The current challenge is that we don’t know how much of the risk associated with falls is directly related to medication use. It could also be attributed to other health conditions.

We want to investigate the safest way to combine antidepressants, antipsychotics and benzodiazepines to treat depression and anxiety in older adults. This type of combination therapy is sometimes needed when:

• A person has difficulty sleeping
• Symptoms or mental conditions are not well-controlled with a single medication

To do this, we will look at patients aged 50 and over with at least one prescription record of antidepressant, antipsychotic or benzodiazepine.

We will apply different observational study designs in a causal framework.

This means that we will use the strengths and weaknesses of each study design to get a better understanding about how much falls and fractures risks can be attributable to psychiatric polypharmacy.

Using these methods to investigate drug-interactions in the field of mental health is novel and experimental (proof-of-concept).

Project aims

We want to identify the optimal approach to combining medication aimed at managing depression and anxiety in older adults.

What we hope to achieve

We anticipate that results from our study will:

• Inform clinical guidelines
• Improve geriatric and psychiatric care in patients
• Help provide patients with informed choice about their medications

This PhD project is funded by the Wellcome Trust. It is led by Aaron Yap and supervised by Dr Paul Madley-Dowd, Dr Deborah McCahon, Dr Eleanor Sanderson and Professor Dheeraj Rai.