title: Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning.
abstract: Depressive symptoms and antidepressant use are associated with greater fall risk in older people. This prospective study investigated interactions between depressive symptoms, antidepressant use and physical and cognitive function measures in relation to injurious or multiple falls in a large sample of community-living older people. Four-hundred and eighty-eight community-dwelling older people aged 70 years and over, underwent a comprehensive psychological, cognitive and physiological assessment and were prospectively monitored for falls over a 12-month follow up period. Substantial depressive symptoms were defined by a Geriatric Depression Scale (GDS) (15-item) score ≥5 and fallers were defined as people who had at least one injurious or two non-injurious falls during follow-up. In univariate analyses, the presence of depressive symptoms (RR=1.50; 95% CI=1.06-2.11), antidepressant use (RR=1.56; 95% CI=1.08-2.27), high physiological fall risk (RR=1.61; 95% CI=1.20-2.15) and poorer executive functioning (RR=1.40; 95% CI=1.05-1.88) were significant risk factors for falls. Multivariate models revealed that depressive symptomatology and antidepressant use were independent of each other, and independent of the presence of a high physiological fall risk and poorer executive functioning in the prediction of falls. Fall risk increased with the number of risk factors present: i.e. by 55% in participants with any two risk factors (RR=1.55; 95% CI=1.17-2.04) and by 144% in participants with three or four risk factors (RR=2.44; 95% CI=1.75-3.43). The study findings indicate that higher depressive symptoms and antidepressant use predict falls over 12-months, independent of reduced executive and physical functioning. Treatment of depressive symptoms using non-pharmacological approaches should be considered as part of fall prevention programs, especially in populations at high risk of falls.
authors.affiliation: Neuroscience Research Australia, UNSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; Department of Psychology, Macquarie University, North Ryde, NSW, Australia.
authors.forename: Tasha
authors.initials: T
authors.lastname: Kvelde
authors.affiliation: Neuroscience Research Australia, UNSW, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: Neuroscience Research Australia, UNSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Clinical School, UNSW, Australia.
authors.forename: Jacqueline C T
authors.initials: JC
authors.lastname: Close
authors.affiliation: Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Australia.
authors.forename: Simone
authors.initials: S
authors.lastname: Reppermund
authors.affiliation: Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Kochan
authors.affiliation: Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Perminder
authors.initials: P
authors.lastname: Sachdev
authors.affiliation: Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW, Australia; Dementia Collaborative Research Centre, UNSW, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.affiliation: Neuroscience Research Australia, UNSW, Australia. Electronic address: k.delbaere@neura.edu.au.
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003071:Cognition; D003863:Depression / Q000188:drug therapy / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents
keywords: Accidental falls; Aged; Antidepressant use; Balance; Cognition; Depression