Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T11:35:06.463Z Has data issue: false hasContentIssue false
  • English
  • Français

Anxiety symptoms during hospitalization of elderly are associated with increased risk of post-discharge falls

Published online by Cambridge University Press:  01 February 2016

Maayan Agmon ,
Anna Zisberg ,
Orly Tonkikh ,
Gary Sinoff  and
Efrat Shadmi
Maayan Agmon*
Affiliation:
The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
Anna Zisberg
Affiliation:
The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
Orly Tonkikh
Affiliation:
The Gerontology Department, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
Gary Sinoff
Affiliation:
The Gerontology Department, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
Efrat Shadmi
Affiliation:
The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Haifa, Israel
*
Correspondence should be addressed to: Maayan Agmon, Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905Israel. Phone: +972 4 8288990; Fax: +972 4 8249753. Email: agmon.mn@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The aim of this study was to test the association between anxiety at the time of hospitalization and falls occurring within one month of discharge, and to offer potential mechanisms for this association.

Methods:

One-month, prospective cohort study of 556 older adults in two medical centers in Israel. Anxiety and functional decline were assessed during hospitalization and falls were assessed one month post-discharge.

Results:

A total of 72 (12.9%) participants reported at least one fall during the 30-day post-discharge period. Controlling for demographics, functional decline and pre-morbid functional status, the odds of falls between discharge, and 1-month follow-up were almost twice as high among patients with anxiety symptoms (OR = 1.89, 95% CI: 1.04-3.48) compared with those who screened negative for anxiety. After accounting for in-hospital functional decline, the relationship between anxiety symptoms and falls decreased by 11% (from OR = 2.13 to 1.89), indicating that the relationship between anxiety and falls was partially mediated by functional decline during hospitalization.

Conclusions:

Anxiety at time of hospitalization is associated with falls 30-days post-discharge, controlling for several well-known confounders. This relationship is partially mediated by functional decline. Identifying patients with anxiety for inclusion in targeted rehabilitation interventions may be an important component of fall prevention strategies.

Keywords

anxiety symptomspost-discharge fallolder adults
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 6 , June 2016 , pp. 951 - 958
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ambrose, A. F., Paul, G. and Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the literature. Maturitas, 75, 51–61.Google Scholar
Balaban, C. D., Jacob, R. G. and Furman, J. M. (2011). Neurologic bases for comorbidity of balance disorders, anxiety disorders and migraine: neurotherapeutic implications. Expert Review of Neurotherapeutics, 11, 379–394.Google Scholar
Baron, R. M. and Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173.Google Scholar
Carpenter, M. G., Frank, J. S., Adkin, A. L., Paton, A. and Allum, J. (2004). Influence of postural anxiety on postural reactions to multi-directional surface rotations. Journal of Neurophysiology, 92, 3255–3265.Google Scholar
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Chu, L.-W., Chiu, A. Y. and Chi, I. (2008). Falls and subsequent health service utilization in community-dwelling Chinese older adults. Archives of Gerontology and Geriatrics, 46, 125–135.Google Scholar
Covinsky, K. E., Pierluissi, E. and Johnston, C. B. (2011). Hospitalization-associated disability: “She was probably able to ambulate, but I’m not sure.” JAMA, 306, 1782–1793.Google Scholar
Davenport, R. D. et al. (2009). Falls following discharge after an in-hospital fall. BMC geriatrics, 9, 53.Google Scholar
Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., La Vecchia, C. and Negri, E. (2010). Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology, 21, 658–668.Google Scholar
Delbaere, K., Sturnieks, D. L., Crombez, G. and Lord, S. R. (2009). Concern about falls elicits changes in gait parameters in conditions of postural threat in older people. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 64, 237–42. doi: 10.1093/gerona/gln014.Google Scholar
Denkinger, M. D., Lukas, A., Nikolaus, T. and Hauer, K. (2015). Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. The American Journal of Geriatric Psychiatry, 23, 72–86.Google Scholar
Dipietro, L., Caspersen, C. J., Ostfeld, A. M. and Nadel, E. R. (1993). A survey for assessing physical activity among older adults. Medicine & Science in Sports & Exercise, 25, 628–642.Google Scholar
Hadjistavropoulos, T., Delbaere, K. and Fitzgerald, T. D. (2011). Reconceptualizing the role of fear of falling and balance confidence in fall risk. Journal of aging and Health, 23, 3–23.Google Scholar
Heinrich, S., Rapp, K., Rissmann, U., Becker, C. and König, H.-H. (2010). Cost of falls in old age: a systematic review. Osteoporosis International, 21, 891–902.CrossRefGoogle ScholarPubMed
Hughes, C., Kneebone, I., Jones, F. and Brady, B. (2015). A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people. International Psychogeriatrics, 27, 1071–1087.Google Scholar
Hull, S. L., Kneebone, I. I. and Farquharson, L. (2013). Anxiety, depression, and fall-related psychological concerns in community-dwelling older people. The American Journal of Geriatric Psychiatry, 21, 1287–1291.Google Scholar
Humphreys, K., Mankowski, E. S., Moos, R. H. and Finney, J. W. (1999). Do enhanced friendship networks and active coping mediate the effect of self-help groups on substance abuse? Annals of Behavioral Medicine, 21, 54–60.Google Scholar
Jang, S.-N., Cho, S.-I., Oh, S.-W., Lee, E.-S. and Baik, H.-W. (2007). Time since falling and fear of falling among community-dwelling elderly. International Psychogeriatrics, 19, 1072–1083.Google Scholar
Knaus, W. A., Draper, E. A., Wagner, D. P. and Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical care Medicine, 13, 818–829.Google Scholar
Krumholz, H. M. (2013). Post-hospital syndrome—an acquired, transient condition of generalized risk. New England Journal of Medicine, 368, 100–102.Google Scholar
Mahoney, J., Sager, M., Dunham, N. and Johnson, J. (1994). Risk of falls after hospital discharge. Journal of the American Geriatrics Society, 42, 269–274.Google Scholar
Mahoney, J. E. et al. (2000). Temporal association between hospitalization and rate of falls after discharge. Archives of Internal Medicine, 160, 2788–2795.Google Scholar
Nagaratnam, N., Ip, J. and Bou-Haidar, P. (2005). The vestibular dysfunction and anxiety disorder interface: a descriptive study with special reference to the elderly. Archives of Gerontology and Geriatrics, 40, 253–264.CrossRefGoogle ScholarPubMed
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433–441.Google Scholar
Prevention, O. F. and Panel, O. S. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49, 664–672.Google Scholar
Scheffer, A. C., Schuurmans, M. J., Van Dijk, N., Van der Hooft, T. and De Rooij, S. E. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing, 37, 19–24.Google Scholar
Sinoff, G., Ore, L., Zlotogorsky, D. and Tamir, A. (1999). Short anxiety screening test—a brief instrument for detecting anxiety in the elderly. International Journal of Geriatric Psychiatry, 14, 1062–1071.Google Scholar
Sinoff, G., Ore, L., Zlotogorsky, D. and Tamir, A. (2002). Does the presence of anxiety affect the validity of a screening test for depression in the elderly? International Journal of Geriatric Psychiatry, 17, 309–314.Google Scholar
Stenhagen, M., Ekström, H., Nordell, E. and Elmståhl, S. (2014). Both deterioration and improvement in activities of daily living are related to falls: a 6-year follow-up of the general elderly population study Good Aging in Skåne. Clinical Interventions in Aging, 9, 1839.Google Scholar
Stubbs, B., Binnekade, T., Eggermont, L., Sepehry, A. A., Patchay, S. and Schofield, P. (2014). Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 95, 175–187. e179.Google Scholar
Stubbs, B., Binnekade, T. T., Soundy, A., Schofield, P., Huijnen, I. P. and Eggermont, L. H. (2013). Are older adults with chronic musculoskeletal pain less active than older adults without pain? A systematic review and meta-analysis. Pain Medicine, 14, 1316–1331.Google Scholar
Tucker, M., Ogle, S., Davison, J. and Eilenberg, M. (1987). Validation of a brief screening test for depression in the elderly. Age and Ageing, 16, 139–144.Google Scholar
Wolitzky Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A. and Craske, M. G. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety, 27, 190–211.Google Scholar
Zecevic, A. A., Salmoni, A. W., Speechley, M. and Vandervoort, A. A. (2006). Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. The Gerontologist, 46, 367–376.Google Scholar
Zijlstra, G., Van Haastregt, J., Van Eijk, J. T. M., van Rossum, E., Stalenhoef, P. A. and Kempen, G. I. (2007). Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age and Ageing, 36, 304–309.Google Scholar
Zisberg, A., Shadmi, E., Gur-Yaish, N., Tonkikh, O. and Sinoff, G. (2015). Hospital associated functional decline: the role of hospitalization processes beyond individual risk factors. Journal of the American Geriatrics Society, 63, 55–62.Google Scholar