Treating the mind, risking the body.

Treating the mind, risking the body

Medications used to ease anxiety, depression and psychosiscan have an unwelcome side effect among the elderly. According to a report in the Feb. 12 NEW ENGLAND JOURNAL OF MEDICINE, a number of these drugs increase the risk of persons over 65 years of age falling and fracturing a hip.

Among elderly Medicaid enrollees in Michigan, Wayne A.Ray of Vanderbilt University School of Medicine in Nashville and his colleagues identified 1,021 patients treated for hip fractures in 1981 or 1982 and 5,606 controls with no hip fractures. Those currently taking an antianxiety drug with effects extending over several days (including Valium), a tricyclic antidepressant (the most commonly used group of drugs to treat depression) or an antipsychotic were substantially more likely to have had a hip fracture. In contrast, persons taking faster-acting antianxiety drugs with effects extending over a day or two had no increased risk of hip fracture.

For the three classes of drugs linked to hip fractures, the riskincreased when higher doses were taken. The association between mind-altering drugs and hip fractures was present in all age groups (subjects 85 years of age and older were compared with younger subjects), in both sexes, in both whites and nonwhites, in both nursing home residents and those living in the community and in subjects with and without recent hospitalization. The increased risk also persisted when subjects with a diagnosis of dementia, which included Alzheimer's disease and senility, were excluded from the study.

The results do not prove that the drugs directly causedelderly subjects to fall and fracture their hips, say the researchers, but there appear to be dangers in the sedative effects of "psychotropic' medication among the elderly, which include confusion, drowsiness and loss of muscle coordination. The scientists say investigations of newer psychotropic drugs with fewer sedative effects will clarify the connection to hip fractures.