Which antidepressants are listed as inappropriate for older adults with history of falls/fractures?

• A. SSRIs, SNRIs, TCAs
• B. Anticholinergics
• C. Benzodiazepines
• D. Z-drugs

Answer: (A)

In older adults who have a history of falls or fractures, medications that worsen balance, cause dizziness, or lead to delirium are a major concern. Among antidepressants, the Beers Criteria flags those with anticholinergic effects and those that can cause orthostatic changes or sedation as higher risk. Tricyclic antidepressants have strong anticholinergic properties and frequently cause orthostatic hypotension and sedation, which directly elevates fall risk. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, while generally safer than TCAs, can still contribute to falls through hyponatremia (which can impair gait and balance) and dizziness, especially in older adults. Because all three classes are associated with increased fall risk in this population, they are listed as inappropriate for someone with a history of falls or fractures, making the combined option the best fit.