Skip to main content Accessibility help
×
Home

Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships

  • Namkee G. Choi (a1), Nancy M. Gell (a2), Diana M. DiNitto (a1), C. Nathan Marti (a1) and Mark E. Kunik (a3) (a4)...

Abstract

Objectives:

Late-life depression, falls, and fall worry are public health problems. While previous research confirms the cross-sectional relationship between depression and fall worry, few longitudinal studies have examined whether changes in fall worry are associated with changes in depressive illness and vice versa. This study examined longitudinal relationships between probable major depression (PMD) and activity-limiting fall worry (ALW).

Design, Setting, Participants, Measurements:

This longitudinal panel observational study used data from the National Health and Aging Trends Study (NHATS) waves 5 (referred to as T1 in this study) and 6 (T2), conducted in 2015 and 2016, respectively (N = 6,299, aged 65 and older). We examined associations of new and continued ALW between T1 and T2 with T2 PMD, controlling for T1 PMD; and associations of new and continued PMD between T1 and T2 with T2 ALW, controlling for T1 ALW. We used χ2 and t tests for descriptive statistics and logistic regression for multivariable analysis.

Results:

Those with new ALW at T2 had significantly greater odds of T2 PMD compared to those without ALW at both time points (AOR = 2.64, 95% CI = 1.98−3.51), and those with new PMD at T2 had significantly greater odds of T2 ALW (AOR = 2.42, 95% CI = 1.66−3.52). Those with continued PMD also had greater odds of T2 ALW compared to those without PMD at either time point (AOR = 2.31, 95% CI = 1.62−3.29).

Conclusions:

The findings add to knowledge about bidirectional (mutually reinforcing) relationships between depression and activity-limiting fall worry. Innovative interventions are needed to reduce both late-life depression and activity-limiting fall worry.

Copyright

Corresponding author

Correspondence should be addressed to: Namkee G. Choi, 1925 San Jacinto Blvd, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA. Phone: 512-232-9590. Email: nchoi@austin.utexas.edu.

References

Hide All
Allison, L. K., Painter, J. A., Emory, A., Whitehurst, P. and Raby, A. (2013). Participation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults. Journal of Geriatric Physical Therapy, 36, 1323. doi: 10.1519/JPT.0b013e3182493d20.
Allison, P. (2015). When can you safely ignore multicollinearity? Available at: https://statisticalhorizons.com/multicollinearity; accessed August 21, 2018.
Auais, M., French, S., Alvarado, B., Pirkle, C., Belanger, E. and Guralnik, J. (2018). Fear of falling predicts incidence of functional disability 2 years later: a perspective from an international cohort study. Journal of Gerontology: Biological and Medical Sciences, 73, 12121215. doi: 10.1093/gerona/glx237.
Bergen, G., Stevens, M. R. and Burns, E. R. (2016). Falls and fall injuries among adults aged ≥65 years – United States, 2014. Morbidity and Mortality Weekly Report, 65, 993998. doi: 10.15585/mmwr.mm6537a2.
Bock, J. O. et al. (2016). Excess health care costs of late-life depression – results of the AgeMooDe study. Journal of Affective Disorder, 199:139147. doi: 10.1016/j.jad.2016.04.008.
Bruce, D., Hunter, M., Peters, K., Davis, T. and Davis, W. (2015). Fear of falling is common in patients with type 2 diabetes and is associated with increased risk of falls. Age and Ageing, 44, 687690. doi: 10.1093/ageing/afv024.
Bryant, M. S., Rintala, D. H., Hou, J. G. and Protas, E. J. (2015). Relationship of falls and fear of falling to activity limitations and physical inactivity in Parkinson’s disease. Journal of Aging and Phys Activity, 23, 187193. doi: 10.1123/japa.2013-0244.
Burns, E. R., Stevens, J. A. and Lee, R. (2016). The direct costs of fatal and non-fatal falls among older adults – United States. Journal of Safety Research, 58, 99103. doi: 10.1016/j.jsr.2016.05.001.
Cacioppo, J. T., Hawkley, L. C., Norman, G. J. and Berntson, G. G. (2011). Social isolation. Annals of the New York Academy of Sciences, 1231:1722. doi: 10.1111/j.1749-6632.2011.06028.x.
Chang, S. C., Pan, A., Kawachi, I. and Okereke, O. I. (2016). Risk factors for late-life depression: A prospective cohort study among older women. Preventive Medicine, 91, 144151. doi: 10.1016/j.ypmed.2016.08.014.
Choi, N. G., Kim, J., Marti, C. N. and Chen, G. J. (2014). Late-life depression and cardiovascular disease burden: examination of reciprocal relationship. American Journal of Geriatric Psychiatry, 22:15221529. doi: 10.1016/j.jagp.2014.04.004.
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. American Journal of Geriatric Psychiatry, 23, 7286. doi: 10.1016/j.jagp.2014.03.002.
Deshpande, N., Metter, E. J., Bandinelli, S., Lauretani, F., Windham, B. G. and Ferrucci, L. (2008). Psychological, physical, and sensory correlates of fear of falling and consequent activity restriction in the elderly: the InCHIANTI study. American Journal of Physical Medicine & Rehabilitation, 87, 354362. doi: 10.1097/PHM.0b013e31815e6e9b.
Eggermont, L. H., Penninx, B. W., Jones, R. N. and Leveille, S. G. (2012). Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the MOBILIZE Boston Study. Journal of the American Geriatric Society, 60, 230237. doi: 10.1111/j.1532-5415.2011.03829.x.
Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J. and Drake, C. (2018). Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatric Society, 66, 693698. doi: 10.1111/jgs.15304.
Frieson, C. W., Tan, M. P., Ory, M. G. and Smith, M. L. (2018). Editorial: evidence-based practices to reduce falls and fall-related injuries among older adults. Frontiers in Public Health, 6, 222. doi: 10.3389/fpubh.2018.00222.
Gell, N. M., Wallace, R. B., LaCroix, A. Z., Mroz, T. M. and Patel, K. V. (2015). Mobility device use among older adults and incidence of falls and worry about falling: Findings from the 20112012 National Health and Aging Trends Study. Journal of the American Geriatrics Society, 63, 853859. doi:10.1111/jgs.13393.
Goh, H. T., Nadarajah, M., Hamzah, N. B., Varadan, P. and Tan, M. P. (2016). Falls and fear of falling after stroke: a case-control study. PM & R: The Journal of Injury, Funation, and Rehabilitation, 8, 11731180. doi: 10.1016/j.pmrj.2016.05.012.
Hall, C. A. and Reynolds-III, C. F. (2014). Late-life depression in the primary care setting: challenges, collaborative care, and prevention. Maturitas, 79, 147152. doi: 10.1016/j.maturitas.2014.05.026.
Hawkins, M. A., Callahan, C. M., Stump, T. E. and Stewart, J. C. (2014). Depressive symptom clusters as predictors of incident coronary artery disease: a 15-year prospective study. Psychosomatic Medicine, 76, 3843. doi: 10.1097/PSY.0000000000000023.
Hoffman, G. J., Ha, J., Alexander, N. B., Langa, K. M., Tinetti, M. and Min, L. C. (2018). Underreporting of fall injuries of older adults: Implications for wellness visit fall risk screening. Journal of the American Geriatrics Society, 66, 11951200. doi: 10.1111/jgs.15360.
Hughes, C. C., Kneebone, I. 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. Interntational Psychogeriatrics, 27, 10711087. doi: 10.1017/S1041610214002701.
Hull, S. L., Kneebone, I. I. and Farquharson, L. (2013). Anxiety, depression, and fall-related psychological concerns in community-dwelling older people. American Journal of Geriatric Psychiatry, 21, 12871291. doi: 10.1016/j.jagp.2013.01.038.
Iaboni, A. and Flint, A. J. (2013). The complex interplay of depression and falls in older adults: a clinical review. American Journal of Geriatric Psychiatry, 21, 484492. doi: 10.1016/j.jagp.2013.01.008.
Iaboni, A. et al. (2015). Depression and outcome of fear of falling in a falls prevention program. American Journal of Geriatric Psychiatry, 23, 10881097. doi: 10.1016/j.jagp.2015.02.006.
Kao, S., Wang, Y., Tzeng, Y., Liang, C. and Lin, F. (2012). Interactive effect between depression and chronic medical conditions on fall risk in community-dwelling elders. International Psychogeriatrics, 24, 14091418. doi:10.1017/S1041610212000646.
Kendrick, D. et al. (2014). Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews, 11, CD009848. doi: 10.1002/14651858.CD009848.pub2.
Kiosses, D. N., Leon, A. C. and Areán, P. A. (2011). Psychosocial interventions for late-life major depression: Evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatric Clinics of North America, 34, 377401. doi: 10.1016/j.psc.2011.03.001.
Kobayashi, L. C. and Steptoe, A. (2018). Social isolation, loneliness, and health behaviors at older ages: Longitudinal cohort study. Annals of Behavioral Medicine, 52, 582593. doi: 10.1093/abm/kax033.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The patient health questionnaire 2: validity of a two-item depression screener. Medical Care, 41, 12841292.
Kvelde, T. et al. (2013). Depressive symptomatology as a risk factor for falls in older people: systematic review and meta-analysis. Journal of the American Geriatric Society, 61, 694706. doi: 10.1111/jgs.12209.
Lachman, M. E., Howland, J., Tennstedt, S., Jette, A., Assmann, S. and Peterson, E. W. (1998). Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). Journal of Gerontology: Psychological and Social Sciences, 53, P43–P50.
Lavedán, A. et al. (2018). Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both? PLoS One, 13(3):e0194967. doi: 10.1371/journal.pone.0194967. eCollection 2018.
Lee, D. et al. (2017). Understanding temporal relationships between depression, falls, and physical activity in a cohort of post-hospitalized older adults – a breakthrough or a conundrum? International Psychogeriatrics, 29, 16811692. doi:10.1017/S104161021700103X.
Lee, S. H. and Kim, H. S. (2017). Exercise interventions for preventing falls among older people in care facilities: A Meta-Analysis. Worldviews on Evidence-Based Nursing, 14, 7480. doi: 10.1111/wvn.12193.
Lenze, E. J. et al. (2007). Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. Journal of the American Geriatric Society, 55, 8186.
Luppa, M., Sikorski, C., Motzek, T., Konnopka, A., König, H. H. and Riedel-Heller, S. G. (2012). Health service utilization and costs of depressive symptoms in late life - a systematic review. Current Pharmaceutical Design, 18, 59365957. doi: 10.2174/138161212803523572.
Lyness, J. M., Yu, Q., Tang, W., Tu, X. and Conwell, Y. (2009). Risks for depression onset in primary care elderly patients: Potential targets for preventions. American Journal of Psychiatry, 166, 13751383. doi: 10.1176/appi.ajp.2009.08101489.
Makino, K. et al. (2018). Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study. International Journal of Geriatric Psychiatry, 33, 658662. doi: 10.1002/gps.4837.
Montaquila, J., Freedman, V. A., Edwards, B. and Kasper, J. D. (2012). National Health and Aging Trends Study Round 1 Sample Design and Selection. NHATS Technical Paper #1. Baltimore: Johns Hopkins University School of Public Health. Available at www.NHATS.org.
Moreira Bde, S. et al. (2016). The geriatric depression scale and the timed up and go test predict fear of falling in community-dwelling elderly women with type 2 diabetes mellitus: a cross-sectional study. BMC Geriatrics, 16, 56. doi: 10.1186/s12877-016-0234-1.
Orgeta, V., Brede, J. and Livingston, G. (2017). Behavioural activation for depression in older people: systematic review and meta-analysis. British Journal of Psychiatry, 211, 274279. doi: 10.1192/bjp.bp.117.205021.
Painter, J. A., Allison, L., Dhingra, P., Daughtery, J., Cogdill, K. and Trujillo, L. G. (2012). Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults. American Journal of Occupational Therapy, 66, 169176. doi: 10.5014/ajot.2012.002535.
Parry, S. W., Finch, T. and Deary, V. (2013). How should we manage fear of falling in older adults living in the community? BMJ, 346, f2933. doi: 10.1136/bmj.f2933.
Parry, S. W. et al. (2016). Cognitive-behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study. Health Technology Assessment, 20,1206. doi: 10.3310/hta20560.
Patil, R., Uusi-Rasi, K., Kannus, P., Karinkanta, S. and Sievänen, H. (2014). Concern about falling in older women with a history of falls: associations with health, functional ability, physical activity and quality of life. Gerontology, 60, 2230. doi: 10.1159/000354335.
Peeters, G., Leahy, S., Kennelly, S. and Kenny, R. A. (2018). Is fear of falling associated with decline in global cognitive functioning in older adults: findings from the Irish Longitudinal Study on Ageing. Journal of the American Medical Directors Association, 19, 248254.e3. doi: 10.1016/j.jamda.2017.09.012.
Stubbs, B., Patchay, S., Soundy, A. and Schofield, P. (2014). The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study. Pain Medicine, 15, 18611871. doi: 10.1111/pme.12570.
Stubbs, B., Stubbs, J., Gnanaraj, S. and Soundy, A. (2016). Falls in older adults with major depressive disorder (MDD): a systematic review and exploratory meta-analysis of prospective studies. International Psychogeriatrics, 28, 2329. doi: 10.1017/S104161021500126X.
Tinetti, M. E. and Williams, C. S. (1997). Falls, injuries due to falls, and the risk of admission to a nursing home. New England Journal of Medicine, 337, 12791284.
van Haastregt, J. C., Zijlstra, G. A., van Rossum, E., van Eijk, J. T. and Kempen, G. I. (2008). Feelings of anxiety and symptoms of depression in community-living older persons who avoid activity for fear of falling. American Journal of Geriatric Psychiatry, 16, 186193. doi: 10.1097/JGP.0b013e3181591c1e.

Keywords

Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships

  • Namkee G. Choi (a1), Nancy M. Gell (a2), Diana M. DiNitto (a1), C. Nathan Marti (a1) and Mark E. Kunik (a3) (a4)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed