Most elderly patients, with cancer are cared for, by a family member who may be affected by various stressors that can influence their health and quality of life (QOL).

To explore depression, quality of life and its related factors among caregivers of elderly patients with cancer.

This is a descriptive and analytical cross-sectional study including 40 primary caregivers of old patients aged 65 or older, with cancer in oncologic radiotherapy service in university hospital Habib Bourguibain Sfax, Tunisia. The short form health survey (SF-36) and Beck inventory (13 items) were used to assess respectively QOL and depression.

The average age of caregivers was 44.62 years. The sex ratio (M/F) was 0.9. Most of caregivers (75%) had impaired QOL (score ˂ 66.7). The two main components of SF-36 were altered with a standard score of 45 for the physical component and 41.1 for mental component. According to Beck inventory, Depression was present in 67.6% of cases. Impaired QOL of life was significantly correlated with somatic illnesses in the caregiver (P = 0.016), advanced stage of cancer (P = 0.01), financial difficulties (P = 0.04), the non-cohabitation with the patient before the disease (P = 0.031) and depression (P = 0.00).

According to our study, caregiving can have a negative effect on the caregiver's mental and physical health. Assistance and information from healthcare professionals are the key to improving the ability of caregivers to cope with caring for older patients with cancer.

The authors have not supplied their declaration of competing interest.

Assessing and quantifying the experience of pain in elderly with cognitive impairment is particularly challenging and important.

To describe the overall profile and to identify the prevalence and characteristics of pain among demented elderly.

A descriptive study including 60 institutionalised elderly aged 65 and older in the retirement home, Sfax, Tunisia. Data collection was conducted using questionnaire exploring socio-demographic and medical data. Mini-mental state examination (MMSE) and Katz index of independence in activities of daily living (ADL) were used to assess respectively mental status and dependence for ADL. Verbal Descriptor Scale (VDS) and elderly behavioural scale (ECPA) were used to evaluate pain. Thirty-two elderly were included and the inclusion criteria were: Age ≥ 65 and MMSE score ≤ 20.

The average age of cognitively impaired residents was 74.2 years with a slight male predominance (57%). They were mostly illiterate (83%) and 56.3% of subjects were single. Almost two-thirds were admitted voluntarily and the average length of stay was 4.8 days. The ADL scale has shown that 65.6% were dependent. According to the VDS, the majority of demented subjects (93.8%) did not feel and express pain, 3% of residents with dementia had mild pain, 2.2% had moderate pain and 1.1% had severe pain. Whereas, the hetero evaluation (ECPA) concluded that 72% of demented elderly actually had pain with severe pain in 18.8% of cases.

Pain in elderly persons with dementia is a significant problem. This underlines high needs of research as well as excellent implementation concepts for assessment and treatment of pain.

The authors have not supplied their declaration of competing interest.

The presence of depressive symptoms impacts negatively the lives of patients suffering from schizophrenia-spectrum disorders. Likewise, the treatment poses many challenges for clinicians.

To specify the profile of elderly with schizophrenia and to evaluate the prevalence of depression and its related factors.

A descriptive and analytic study involved 40 elderly patients aged 65 and over with DSM-5 diagnoses of schizophrenia or schizoaffective disorder, followed to the outpatient psychiatry department of Hedi Chaker University Hospital, in Sfax, Tunisia, during the two months of September and October 2015. Positive and negative syndrome scale (PANSS) and Calgary depression scales were used to assess respectively the symptoms of schizophrenia dimensionally and depression.

The majority of our patients was male (62.5%), single (55%), with low school and socioeconomic level. The mean duration of disease was 45 ± 6.02 years and patients were mostly (90%) in classical neuroleptics. The scale of PANSS showed the predominance of negative symptoms (67.5% of cases). In addition, according to Calgary scale, depression was found in 25% of patients. Factors positively correlated to depression were: the female sex among single (P = 0.043), absence of family support (P = 0.001), treatment with conventional neuroleptics (P = 0.039) and negative symptoms (P = 0.001).

Depression in patients with schizophrenia is far from exceptional. It is often difficult to diagnose due to the recovery of other symptoms.

The authors have not supplied their declaration of competing interest.

Diagnosis of Alzheimer disease is mainly clinical, based on longitudinal history and clinical criteria due to lack of specific biochemical tests and neuroimaging studies. Deficient central cholinergic activity of AD pathology is said to be reflected as decreased peripheral cholinergic activity. Assessing peripheral cholinergic function with pupillometer for diagnostic and prognostic purpose may be beneficial, as it may be a non-invasive, acceptable, and easily administered diagnostic tool if proven so.

This is a single point case control pilot study with sample size of 45 (25 AD patient and 20 controls). CAMDEX-R based interview, HMSE, and DSM-IV criteria were used for detailed assessment and diagnosis. The pupillometric parameters (Horizontal and vertical diameters of pupil) were measured by Oasis Colvard pupillometer (SKU-0401A) under three conditions namely after 5 minute of dark adaptation in dark room (PD-5min-DA i.e. Baseline PD); after 5 minutes (PD-5min-T) and 15 minutes (PD-15min-T) of instillation of 2–3 drops of 1.0% Tropicamide.

There was no difference in baseline pupil diameter (horizontal + vertical) of AD patients and age matched healthy controls. 1% tropicamide induced significant increment in pupil diameters from baseline to after 5 (‘PD-5min-T’) and 15 minutes (‘PD-15min-T’) of its instillation in both AD patients and age matched healthy controls. But tropicamide induced increment in pupil diameters were approximately equal in cases and controls.

The study did not find the role of 1% tropicamide induced pupillary hypersensitivity in AD patients for diagnostic purpose.

The authors have not supplied their declaration of competing interest.

The Alzheimer's patient assistance relationship is a morally painful experience, most frequently discussed in terms of “burden” in the literature, especially as professionals and institutional intermediaries are underdeveloped in Tunisia.

It is intended to assess the level of burden among caregivers of patients with Alzheimer's disease and to search factors associated with a high level of burden.

This is a retrospective descriptive study. Patients were recruited from neurology department of Razi hospital, which were hospitalised between the months of December 2012 and March 2013. The burden was measured using the Zarit inventory.

Thirty patients were included. The majority female, most caregivers are descendants (60%), then, daughters in law (33%), and finally the spouses (23%). 80% of caregivers lived in the same home as patients. Caregivers were asked about all the items of the grid Zarit. The average burden in our sample is 59.9 + 16 3. We observed that 33% have absent to light burden (score <21), 10% have a light to moderate burden (between 21 and 40), 36, 66% have moderate to severe burden (between 41 and 60) and 50% have a severe burden (>60), according to the classification proposed by Zarit. Sex, kinship and cohabitation with the patient were not associated with a higher burden.

The study of factors correlated with high levels of burden aims at finding ways of intervention and support to fight against the isolation of caregivers and the occurrence of anxiodepressive complications.

The authors have not supplied their declaration of competing interest.

Twenty percent of people aged over 80 have a serious dementia. Cognition disturbances are present both in depressive disorder and dementia. Vortioxetine is a new antidepressant with a multi-modal mechanism of action, being one of the antidepressant with more procholinergic action.

to know the efficacy of vortioxetine in elder people with cognitive disturbances due to both pathologies: depression and dementia.

It is described the result of using vortioxetine in one elder woman with dementia and affective symptoms with no clinical improvement after using two classical antidepressants.

Woman aged 82 without psychiatric history came to our consultation in April 2016. She had been diagnosed with dementia last year by a neurologist and she had started treatment with Donepezile 10 mg/d. Six months after this diagnosis she complained of depressive mood and faster deterioration of her previous cognition disturbances in terms of functionality level and autonomy, so her neurologist prescribed escitalopram until 10 mg/d and mirtazapine until 30 mg/d without clinical improvement. After first exploration, we decided starting treatment with vortioxetine 10 mg/d and withdraw previous antidepressants. Next week she complained of nausea and vomiting so we reduced the dose to 5 mg/d with good tolerance after that moment. Six months later her depressive mood had improved and her family remarked she had a little more autonomy and more desire to do things.

Vortioixetine might be an effective and safe option in elder people who have cognitive disturbances due to mood disorder and/or dementia, probably because of its procholinergic action.

The authors have not supplied their declaration of competing interest.

In this study we aimed to explore the role of inflammation in subjects with mild Alzheimer dementia (AD), mild cognitive impairment (MCI) and subjective cognitive decline (SCD) via new potential inflammation markers of Neutrophil-lymphocyte ratio (NLR) and Platelet-lymphocyte ratio (PLR). NLR and PLR are useful and cost-effective biomarkers, showing peripheral systemic inflammation, were previously shown in neuropsychiatric disorders [1].

In screening phase the patients were assessed with mini-mental state examination, clinical dementia rating scale (CDR), geriatric depression scale (GDS) and Hachinski Ischemic Scale (HIS) after unstructured psychiatric interview according to diagnostic and statistical manual of mental disorder, Text Revised (DSM-IV, TR). Spectrum of cognitive decline includes 31 patients with mild Alzheimer's disease, 30 subjects with mild cognitive impairment, 31 individuals with subjective cognitive decline. Thirty-one healthy controls enrolled to the study.

NLR value of patients with AD was 2.38 ± 0.81, subjects with MCI was 2.48 ± 1.19, SCD group was 2.24 ± 1.11 and control group was 1.85 ± 0.80. NLR was significantly higher in AD and MCI groups when compared with control group (P = 0.006, P = 0.03, respectively). Platelet-lymphocyte ratio was not correlated with cognitive impairment. Neutrophil counts were indifferent when comparing either of groups. Lymphocyte levels were significantly lower in each of cognitive decline groups when compared to healthy controls.

The present findings suggest that systemic inflammation may have a role in developing Alzheimer's Disease.

The authors have not supplied their declaration of competing interest.

Acute angle-closure glaucoma (AACG) is an ophthalmic emergency, accompanied with severe eye pain, headache, and visual changes because of acute intraocular pressure elevation. Among psychotropic drugs, several antidepressants, typical antipsychotics with strong anticholinergic effects, and topiramate have been known to increase a possibility of AACG. Benzodiazepines have been used widely in the treatment of mental and physical illnesses regardless of age or indication. Since benzodiazepines have some anticholinergic properties and affect pupillae muscles, their use could be theoretically a risk factor for AACG. However, it is unclear whether benzodiazepines actually increase the risk of AACG. To our knowledge, there was no population-based study on the risk of benzodiazepines to the occurrence of AACG.

To know whether benzodiazepines increase the risk of AACG in a geriatric population.

We will perform a case-control study using a geriatric cohort from the National Health Insurance database. Case subjects will be defined as cases diagnosed with AACG confirmed by the claim data of laser iridotomy, which is the definitive treatment of AACG. The controls, which were not diagnosed with AACG, will be matched with case subjects according to similar age, sex, and the scores of the Charlson comorbidity index.

The data handling and statistical analyses will be executed in autumn and winter 2016.

Any preliminary findings of this study will be presented at the EPA 2017. We will discuss the importance of a pharmaco-epidemiological study in the geriatric research.

The authors have not supplied their declaration of competing interest.

Losing one's spouse is a major life event which is associated to an increased risk of mental health problems as depression and sleep-disorders. There is also an increased risk of adverse effects on physical health, and even an increased risk of mortality. A phenomena called “the widowhood effect” Though this is well-known clinically, few studies have established the extent of the problem in old age.

This study aims to examine the risk of mortality associated to widowhood in old age, and adverse health effects both regarding physical and mental health.

A nationwide register-based case control study. All Danish people aged 65 years and above who became widowed in the period of 2000–2010 are included. A background population sample of 4:1 is matched on age and gender. By using the personal identification number a linkage between registers containing information regarding health service use, pharmacologic use and demographic information is made. Mortality is analysed using Kaplan-Meier estimate and the statistical comparison between the groups is done by Cox-regression. Adverse health effects are assessed by the health care use and pharmacological use, and are compared between the two groups by t-test, linear and logistic regression depending on the variables.

The study is under conduction, results will be presented.

Widowhood in old age has been associated to an increased risk of mortality and adverse health effects. This study assesses the outcome of this in a nationwide register-based sample.

The authors have not supplied their declaration of competing interest.

Parkinsonism as a clinical syndrome needs to be diagnosed multidisciplinary. Cognition problems and behavioural symptoms together with the neurologic symptomatology make the treatment very complicated.

To emphasize the importance of effective management strategies that may extend quality of life and independence.

This is a case report of 59 year old male with complicated clinical presentation of dementia with parkinsonism last two years treated with levodopa. Admitted with symptoms of fluctuating cognition, memory problems, visual hallucinations and depression and also generalized rigidity after introduction of atypical antipsychotic. Medical history: epilepsy in the last 15 years, trauma 7 years ago. After admission he was examined clinically and the brain computed tomography (CT) and electroencephalography (EEG) were done.

We analyzed possible etiologies and differential diagnosis of presented symptoms–extrapyramidal signs, mental confusion with hallucinations which are the three most common clinical features of Parkinson's disease dementia (PDD). CT reveals diffuse cortical atrophy with encephalopathy in the white matter combined with dilatation of lateral ventricles. EEG was with theta disrhythmic activity. After consultation with neurologist the patient was given Carbamazepine for epilepsy and Levodopa/Carbidopa to control parkinsonism. Donepezil was introduced. Two weeks after admission the patient was discharged with given advice to be treated in geriatric clinic.

After thorough clinical examination with proper diagnostic procedures with imaging modalities we should try cholinesterase inhibitors because they might improve cognition and can be beneficial for reduction of the hallucinations and behaviour disturbances combined with proper management of the surroundings.

The authors have not supplied their declaration of competing interest.

Bipolar disorder in elderly patients may present as an evolution of the disease initiated in younger stages or as an entity newly emerging. In addition, mania in the elderly, has characteristics that make it different from the adult. These disorders can be correlated with underlying vascular or degenerative disorders [1].

Review of the relevant literature by searching PUBMED, limited to studies of greater scientific hierarchy.

The existence of changes in the manic phase motivated by the influence of vascular disease, as well as the importance of the changes experienced in therapy at the rate of underlying organic disease described. The useful pharmacotherapeutic approach in this case is discussed.

The most recent research points in the direction of a more organic for mania late age-related substrate. The diverse etiology requires differential diagnosis for addressing the underlying causes [1]. The clinic does not dim with age, but increases the tendency to develop rapid cycling as age progresses. It is also more frequent occurrence of paranoid and aggressive traits, especially in situations of confrontation, along with increased dysphoria [2]. The therapeutic management by neuroleptics require very careful attention, because of the vulnerability of this group to develop adverse effects. Mood stabilizers use has been demonstrated as effective as in young [2].

The authors have not supplied their declaration of competing interest.

In the older adult hypochondria is one of the most common somatoform disorders, and represents a particular challenge for approach, diagnosis and treatment, since in this age group, non-psychiatric medical comorbidity and concomitant presence of other psychiatric disorders very high. It is therefore very complex differentiate hypochondria disease with a real organic cause [1].

Review of the relevant literature on the subject by searching PUBMED, limited to studies of greater scientific hierarchy.

Analysis of symptoms present in a hypochondriac patient with comorbid psychiatric disorders and organic pathology, valuing the importance it has in its clinical manifestations and the difficulty of differential diagnosis.

In the elderly, the high frequency of somatic disease conditions the need for a deeper physical and mental examination to avoid subjecting patients to unnecessary scrutiny and risky complementary tests [1].

The evolution of hypochondriacs, dragging hypochondria from youth is not good, persisting in his complaint and his need to see a doctor for diagnostic examinations [2]. The therapeutic approach depends on the type of complaint, in which the treatment of the underlying disease as a psychotherapeutic and pharmacological mixed approach may be the right things [2].

The authors have not supplied their declaration of competing interest.

Behavioural and psychological symptoms (BPSD) are frequent in dementia and their contribution to poor health outcomes is well recognized. Four major frameworks attempt an explanation their aetiology: biological, behavioural, environmental vulnerability and unmet needs models. The latter states that BPSD are symptoms of needs that are not being met due to patients’ decreased ability to communicate/fulfil them. This model also implies that if needs were met, BPSD would improve.

To explore the relation between needs and BPSD, and describe which unmet needs were contributing to BPSD in an elderly sample.

A cross-sectional study was conducted in three Portuguese nursing homes. All residents were considered eligible. However, those unwilling or unable to participate were excluded. For each elderly patient, needs were assessed with camberwell assessment of need for the elderly/cane and BPSD with European Portuguese neuropsychiatric inventory/NPI.

The final sample included 166 elderly with an average of 80.9(sd = 10.2) years. Significant correlations between NPI and unmet and global needs were found (rs = 0.181,P = 0.020; rs = 0.254,P = 0.001, respectively). Additionally, the unmet needs of daytime activities (P = 0.019), company (P = 0.028) and behaviour (P = 0.001), presented significant correlations with NPI.

In this sample, a high number of unmet needs were found. The absence of daytime activities, company and behaviour contributed to the identified BPSD, which is in line with other studies also highlighting the importance of these needs in nursing homes. This not only provides a framework for understanding BPSD, but also points to the identification of unmet needs as pivotal in prevention and treatment of these symptoms.

The authors have not supplied their declaration of competing interest.

Demographic changes with the aging of the worldwide population imply an increase in prevalence of chronic diseases, such as diabetes mellitus. Many studies have suggested that depression is higher in diabetic patients, and that this association often contributes to under-recognition of the illness, limiting adequate metabolic control.

To study the association between depression and adherence to treatment in elderly diabetic patients.

A cross-sectional study was conducted with elderly outpatients (≥65 years) from the Internal Medicine Department in São João Hospital (CHSJ, Porto). Patients unable to communicate were excluded. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale/HADS, and adherence to treatment with a clinical interview and from medical records.

The final sample included 78 patients, with an average of 75.3 (sd = 6.75) years. They were mostly female (80%), married (66.7%) and with low education level (62.8%). The mean number of comorbidities was 5.76 (sd = 1.6) and 98.7% took ≥5 drugs. In this sample, 23.1% had cognitive impairment, 16.7% depression and 24.4% anxiety. Patients not adhering to treatment presented a higher depression score, when compared with adherents (median 6vs3), even without statistical significance (P = 0.56).

Diabetic patients not adhering to treatment tend to present more depression, in spite of the lack of statistical significance. These results suggest that depression can limit the adherence to treatment, which is in line with previous studies. In this context, the early diagnosis and treatment of depression seems to be an important target in the management of diabetes, particularly in elderly patients.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Delirium is a frequent and serious acute neuropsychiatric syndrome, namely in elderly hospitalised patients, described as a psychologically traumatic experience by patients, family/caregivers and health professionals(HPs). In this context, the Delirium Experience Questionnaire (DEQ) was developed as a face-valid instrument assessing the delirium experience recall and the degree of distress related to delirium episodes in patients, family/caregivers, and HPs.

To present the translation and cultural adaptation of the Portuguese version of DEQ (DEQ-PT).

The translation process followed ISPOR guidelines. After preparation, forward translation, reconciliation, back translation, back translation review, harmonization and cognitive debriefing (involving experts’ consensus), the DEQ-PT was tested (pre-test) in a group of elderly patients with delirium(≥ 65 years) in two Intermediate Care Units (Intensive Care Medicine Service-CHSJ, Porto). Exclusion criteria were: brain injury, blindness/deafness, unable to communicate, and Glasgow Coma Scale ≤ 11. Their families were also assessed, as well as the HPs (physicians/nurse) in charge of patients during hospitalisation.

After obtaining permission to use the instrument, the DEQ was successfully translated into Portuguese, with harmonization of all new translations. Pre-test included a group of 5 patients, 5 families and 5 nurses. This version revealed good cognitive equivalence with the original English version and also a good level of comprehensibility.

The DEQ-PT showed good feasibility, being suitable, quick and easy to use in the assessment of delirium experience in intermediate care units. These findings will be further developed by an ongoing validation study.

This work was supported by foundation for science and technology (SFRH/BPD/103306/2014).

The authors have not supplied their declaration of competing interest.

Tunisia has experienced a considerable increase in degenerative diseases associated with aging including in particular dementia and Alzheimer's disease.

To evaluate the diagnostic procedures of cognitive impairments in general medicine and to identify obstacles concerning the early diagnosis of dementia in these patients.

An email questionnaire was sent to a sample of general practitioners (GPs) working in the Sfax region, Tunisia.

We received 55 answers. When facing a mnesic complaint, 20% of GPs perform a screening of cognitive disorders. Among reasons leading to early identification, memory complaints (76.4%) was the most mentioned by GPs surveyed. the Mini Mental State was the most used (34.5%) by general practitioners. Twenty-nine point one percent (29.1%) of physicians conducted a comparative assessment 6 to 12 months later if the initial evaluation was normal and 83.6% send the patient to a specialist in case of a detected disorder. For GPs, in 58.2% of the cases, the major impediment is the lack of time, in 32.7% of the cases it is patient's and family's denial and in 23.6% of the cases it is the absence of effective medical treatment. A cross analysis shows that GPs who have had further training in geriatrics have a better approach.

Our study shows a lack in the early identification of cognitive impairment in the elderly by GPs. Develop simple cognitive tests, reinforce training of doctors and promote research to develop new drugs would improve early diagnosis and management of dementia.

The authors have not supplied their declaration of competing interest.

Antipsychotic medication use may be associated with prolongation of the QTc interval, increasing the risk of potentially fatal arrhythmias [1]. This is particularly pertinent in the elderly due to comorbid cardiovascular disease and polypharmacy. Attention to the ECG and co-prescribed medications is essential to minimise cardiac risk when prescribing antipsychotics.

On 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified as part of a hospital-wide survey. Data was collected from medical and electronic patient notes and medication kardexes.

Complete data was obtained for 36 patients aged over 65 who were newly-prescribed an antipsychotic or had their antipsychotic changed. Of these, 39%(n = 13) had a cardiac history. One quarter did not have an ECG in the 12 months preceding antipsychotic initiation. Of the 28 patients with an ECG, 57% (n = 16) had a QTc > 450ms before starting antipsychotic treatment. Only 11% (n = 4) had an ECG within 24 hours of starting the antipsychotic. The average change of the QTc interval in those with a repeat ECG was 30msecs. 42% (n = 15) were co-prescribed another QTc-prolonging medication.

Current monitoring of QTc interval in an elderly population newly prescribed antipsychotic medications is inadequate and a cause for significant safety concerns. Education and clear guidance is warranted to improve safety and minimise risk in this population.

The authors have not supplied their declaration of competing interest.

A 71 year old gentleman presented with two discrete episodes of delirium with prominent psychotic features and catatonia, over a 3-year period. Symptomatically, he was suffering from fluctuating consciousness, paranoid ideation and both auditory and visual hallucinations. He went on to develop catatonia, demonstrating negativism and mutism and he also exhibited pseudoseizures. His symptoms resolved entirely after three weeks. He re-presented 3 years later with profound psychosis and hyponatraemia. On this occasion, he exhibited catalepsy, negativism, echolalia and mutism, which resolved when his sodium was corrected.

To illustrate 2 episodes of acute catatonia temporally associated with hyponatraemia in an otherwise healthy elderly gentleman.

This is a case study. Consent was sought from the patient to write up his case and distribute it for educational purposes. His medical inpatient notes, psychiatric inpatient notes, correspondence and bloods pertaining to both admissions were reviewed and analysed. A literature review was carried out using Pubmed.

Low sodium levels were a common factor in his presentations and normal sodium levels were associated with a return to normal consciousness.

While medical issues confounded his first presentation of hyponatraemia associated catatonia, his second presentation was directly related to hyponatraemia. Given the coincidence of hyponatraemia during his first admission, it would strongly suggest that low sodium levels were an important factor in this gentleman's presentation. Importantly, this is the first case in the literature to demonstrate catatonia related to hyponatraemia on two separate occasions in the same individual.

The authors have not supplied their declaration of competing interest.

Falls of the elderly to a degree been associated with poor mental health, poor social support and poor physical health.

To investigate the falls of elderly people in relation to their mental and physical healthy.

To compare the effects of falls in the elderly in the areas of mental and physical health.

The current study used purposive sampling compromised from 48 people that visited the emergency department at the Patras University Hospital in 2016. The inclusion criterion for participation was age (> 65 years). Data was collected using WHO's questionnaire, the WHOQUOL-BREF. Finally, data was analyzed using the test t test for independent samples.

The sample constituted by 39.6% of male and 61.4% of female. The average age of the sample was M = 75.89 years. In relation to mental health, the average of the elderly with a history of falls found M = 57.26 (SD = ± 22.87), while the other was found M = 74.45 (SD = ± 15.81). The difference between the two groups was statistically significant (P < 0.05), while physical health although again the first group found to have a smaller average (M = 56.65, SD = ± 22.13) relative to the second group (M = 63.78, SD = ± 12.59) no statistical difference was observed.

These results demonstrates that falls beyond the physical damage that are immediately visible can as well create significant issues in the psychological state of the elderly exacerbating anxiety, fear and social isolation, which has been associated with depression event.

The authors have not supplied their declaration of competing interest.