Falls and cognitive decline in Mexican Americans 75 years and older.
BACKGROUND
Little is known about long-term emotional and cognitive consequences of falls. We examined the association between falls and subsequent cognitive decline, and tested the hypothesis that depression would mediate any falls-cognition association among cognitively intact Hispanic Elders.


METHODS
We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine change in Mini Mental State Examination (MMSE) scores over the 6-year period according to number of falls. All participants (N=1,119) had MMSE scores ≥21 and complete data on Center for Epidemiologic Studies of Depression Scale, social and demographic factors, medical conditions (diabetes, heart attack, stroke, and hypertension), and hand grip muscle strength.


RESULTS
At baseline, participants' mean age was 80.8 years (range, 74-109), mean education was 6.3 years (range, 0-17), and mean MMSE was 25.2 (range, 21-30). Of the 1,119 participants, 15.8% experienced one fall and 14.4% had two or more falls. In mixed model analyses, having two or more falls was associated with greater decline in MMSE score (estimate =-0.81, standard error =0.19, P<0.0001) compared to having no fall, after adjusting for age, sex, marital status, and education. The magnitude of the association decreased (estimate =-0.65, standard error =0.19, P=0.0007) when adjustment was made for high depressive symptoms, suggesting a possible mediating effect of depression on the falls-cognition association. Female sex, high level of education, and high performance in hand grip muscle strength were associated with a slower decline in MMSE scores.


CONCLUSIONS
Having two or more falls was independently associated with steeper decline in cognition over 6 years, with a possible mediating effect of depression on the falls-cognition association.
College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA ; Sealy Center on Aging, Galveston, TX, USA.
Anokha
A
Padubidri
Sealy Center on Aging, Galveston, TX, USA ; Division of Rehabilitation Sciences, School of Health Professions, the University of Texas Medical Branch, Galveston, TX, USA.
Soham
S
Al Snih
Sealy Center on Aging, Galveston, TX, USA ; Department of Internal Medicine, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Columbia.
Rafael
R
Samper-Ternent
Sealy Center on Aging, Galveston, TX, USA ; Department of Preventive Medicine and Community Health, Bogota, Columbia.
Kyriakos S
KS
Markides
Sealy Center on Aging, Galveston, TX, USA ; Division of Rehabilitation Sciences, School of Health Professions, the University of Texas Medical Branch, Galveston, TX, USA.
Kenneth J
KJ
Ottenbacher
Sealy Center on Aging, Galveston, TX, USA ; Department of Internal Medicine, the University of Texas Medical Branch, Galveston, TX, USA.
Mukaila A
MA
Raji
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D004522:Educational Status; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000523:psychology / Q000706:statistics & numerical data*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
cognition; depression; elderly