Abstract

Objectives

Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression.

Method

We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010–2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls.

Results

Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression.

Conclusion

Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.

中文翻译：

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虚弱在老年人抑郁和跌倒风险之间的关联中的作用

摘要

目标

尽管抑郁症与老年人跌倒风险增加之间存在公认关联，但解释这种关联的机制尚不清楚。这项研究评估了虚弱（一种常见的老年综合症）在确定患有抑郁症的老年人跌倒的更大风险中的作用。

方法

我们使用了健康与退休研究 (HRS; 2010–2014) 的三个双年度浪潮的纵向数据。样本包括参与客观生理测量的年龄≥65 岁的社区调查受访者。使用针对抑郁症的综合国际诊断访谈简表测量重度抑郁症 (MD)。使用虚弱表型模型中概述的标准测量虚弱。因果中介分析用于区分抑郁的直接影响和虚弱对跌倒、跌倒损伤和多次跌倒的间接影响。

结果

严重抑郁症与跌倒 (OR: 1.91; 95% CI: 1.31, 2.77)、跌倒损伤 (OR: 1.86; 95% CI: 1.17, 2.95) 和多次跌倒 (OR: 2.26; 2.26;两年期间的 95% CI：1.52、3.37）。虚弱是抑郁症对跌倒和多次跌倒影响的重要中介，分别占总影响的约 18.9% 和 21.3%。我们没有发现抑郁症与虚弱相互作用的证据。敏感性分析表明，结果对于未测量的混杂和抑郁症的替代操作是稳健的。

结论

虚弱解释了患有抑郁症的老年人跌倒可能性增加的很大一部分。虚弱症状的治疗和管理可能是抑郁症老年人预防跌倒的重要组成部分。