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.