Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo due to a peripheral vestibular disorder. BPPV has been reported in adults of all ages, but it is rare in children. People with BPPV usually have a spinning sensation that is triggered by such activities as lying down, rolling over in bed, and bending over and looking up. Most often, BPPV occurs spontaneously, but it also may follow head trauma, neuritis affecting the superior vestibular nerve, or ischemia in the distribution of the anterior vestibular artery. BPPV is a mechanical problem resulting from displacement of otoconia from the utricle to one of the semicircular canals (SCCs) of the inner ear. Physical therapists confirm a diagnosis of BPPV by observation of nystagmus—involuntary eye movement–when the patient is placed in a position that provokes symptoms. Treatments primarily are based on the SCC involved, generally take only a few minutes to perform, and have a high rate of success.

SSRIs Linked With Increased Falls Risk in Nursing Home Residents

Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are 3 times more likely to have an injurious fall than similar people who don’t use these drugs, according to the British Pharmacological Society.

SSRIs are generally considered the treatment of choice for nursing home residents with dementia and who have depression. The risk of falling increases as people take higher doses.

Researchers recorded the daily drug use and daily falls in 248 nursing home residents with dementia from January 2006 until January 2008. Data about the residents’ day-by day drug use came from a prescription database, and information on falls and subsequent injuries came from a standardized incident report system. In total, they collected a dataset of 85,074 person-days.

The mean age of the participants was 82 years. The prescription records showed that antidepressants had been used on 13,729 (16.1%) days, with SSRIs being used on 11,105 of these days.

The incident reports showed that 152 of the 248 residents (61.5%) sustained 683 falls, corresponding to a fall incidence of 2.9 falls per person-year. Thirty-eight residents had a single fall; 114 fell more frequently. Of the 220 falls recorded, 10 resulted in hip fractures, 11 in other fractures, and 198 in injuries such as grazes, open wounds, sprains, bruises, and swellings. One person died after falling.

The risk of having an injurious fall increased threefold for residents taking SSRIs, from an absolute daily risk of 0.09% for a female aged 80 not taking an SSRI, to 0.28% for a female aged 80 taking 1 defined daily dose of SSRIs. Similar increases in absolute daily risk were found for both men and women, for different ages.

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