Persistence of depressive symptoms and gait speed recovery in older adults after hip fracture.

Abstract

Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance. Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n=284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2-month and 6-month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time-averaged severity lagged to standardized 3m gait speed at 2, 6, and 12months. A 1-unit increase in time-averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of -0.0076 standard deviations (95% confidence interval [CI]: -0.0184, 0.0032; P=.166). The association was largest in magnitude from baseline to 6months: -0.0144 standard deviations (95% CI: -0.0303, 0.0015; P=0.076). Associations for the other time intervals were smaller: -0.0028 standard deviations (95% CI: -0.0138, 0.0083; P=.621) at 2months and -0.0121 standard deviations (95% CI: -0.0324, 0.0082; P=.238) at 12months. Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6months after hip fracture has a meaningful impact on functional recovery.