The role of depressive symptoms in recovery from injuries to the extremities in older persons. A prospective study.
BACKGROUND
Previous research suggested that depressive symptoms play a role in recovery after hip fracture. However none of these studies were prospective and included only patients with hip fractures.


OBJECTIVE
To examine the effect of depressive symptoms on the recovery of (instrumental) activities of daily living after fall-related injuries to the extremities in older persons.


METHODS
Prospective cohort study.


METHODS
Data were collected from 168 older persons at baseline, prior to their injuries (hip fractures, other fractures or contortions and dislocations), and 8 weeks, 5 months and 12 months after their accident. Hierarchical multiple regression analysis was used to study the impact of depressive symptoms (as assessed with the Hospital Anxiety and Depression Scale; HADS) on disability (as assessed with the Groningen Activity Restriction Scale; GARS) after the injury while adjusting for several covariates.


RESULTS
Depressive symptoms at baseline were not predictive for disability after the injury when covariates were taken into account. However, depressive symptoms 8 weeks after the fall were significantly related to disability at 8 weeks, 5 months and even 12 months after the injury. In addition, disability levels before the injury were highly predictive for recovery later on. Severity of injury was particularly predictive for disability at 8 weeks while age (which may generally represent the amount of physiological reserve) predicted disability at 5 and 12 months after the injury. Cognitive functioning 8 weeks post-injury was, in contrast to previous research, not predictive for recovery when covariates were taken into account.


CONCLUSIONS
Pre-injury levels of disability and post-injury depressive symptoms are associated with recovery and may warrant concern and special attention in clinical practice.
Kempen
Gertrudis I J M
GI
Department of Health Care Studies, Section of Medical Sociology, Maarstricht University, Maarsstricht, The Netherlands. G.kempen@zw.unimaas.nl
Sanderman
Robbert
R
Scaf-Klomp
Winnie
W
Ormel
Johan
J
D000058:Accidental Falls; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000523:psychology / Q000534:rehabilitation*; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000523:psychology / Q000534:rehabilitation; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007869:Leg Injuries / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012307:Risk Factors