Regular Research Article
Depression and Outcome of Fear of Falling in a Falls Prevention Program

https://doi.org/10.1016/j.jagp.2015.02.006Get rights and content

Objective

To examine whether depression predicts less improvement in fear of falling and falls efficacy in older adults attending a falls prevention program (FPP).

Methods

Using a prospective observational design in an academic medical center, the authors studied 69 nondemented adults aged 55 years or older (mean age: 77.8 ± 8.9 years) who had experienced at least one fall in the previous year and who attended the FPP. The primary outcome variable was change in severity of fear of falling during the FPP. Secondary outcome variables were change in falls efficacy and fear-related restriction of activities during the FPP. Independent variables were baseline depressive disorders and depressive symptom severity.

Results

Twenty-one of 69 study participants (30.4%) had a depressive disorder at baseline. Depressive disorder and depressive symptoms were not associated with change in severity of fear of falling or restriction of activity. On the other hand, depressive disorder was associated with improvement in falls efficacy, although this finding was not significant in multivariate analysis. Among participants with a depressive disorder, improvement in falls efficacy was significantly correlated with improvement in depressive symptoms.

Conclusion

There was no association between baseline depression and change in fear of falling in this FPP. The correlation between improvement in depressive symptoms and improvement in falls efficacy raises the question as to whether a cognitive-behavioral intervention that simultaneously targets both depression and falls efficacy would be a useful component of a FPP.

Introduction

Fear of falling is a common and potentially serious complication of falling. Approximately 50% of older persons who fall develop fear of falling1, 2, 3 and 25% of fallers will restrict activities because of this fear.1, 4 Fear of falling can also occur in individuals who have not fallen. Fear of falling and the associated avoidance of activities can result in deconditioning, functional decline, risk of future falls, social isolation, and impaired quality of life.5, 6

The most common strategies used to manage fear of falling are balance training, low intensity exercise, and attention to fall risk factors.7, 8 These interventions are often administered together in a falls prevention program (FPP).9, 10 However, although these strategies have been found to improve a person's fall self-efficacy and balance confidence, they have little or inconsistent impact on the fear itself.7, 8 Moreover, even if the fear does improve, the improvement is usually not sustained once the intervention ends.11, 12

Fear of falling is strongly associated with depressive symptoms and depressive disorders.5, 13, 14, 15 Gagnon et al.14 found that 37.5% of older fallers with moderate or severe fear of falling had a current depressive disorder and depression accounted for more of the explained variance in fear of falling than other known risk factors for this fear. Depression can be associated with persistence of anxiety16, 17: In community samples, depression was found to predict the persistence of both fear of falling3 and fear-related activity restriction.1 This raises the question as to whether the lack of improvement in fear of falling in treatment programs is attributable, at least in part, to a moderating effect of depression. To address this issue, we examined whether depressive disorders and depressive symptom severity predict less improvement in fear of falling in a FPP.

Section snippets

Study Design

This was a prospective study of patients enrolled in a hospital-based FPP in Toronto from September 2010 to July 2012. FPP participants were approached by the research team to participate in this study after having been independently assessed and selected for FPP attendance by the interprofessional falls clinic staff. Research subjects were assessed at three time points: (1) baseline (within 2 weeks of starting the FPP), (2) midpoint (at the sixth FPP session), and (3) final (within 2 weeks of

Study Sample

One hundred twenty-five individuals who had been accepted into the FPP were contacted for research participation, of whom 37 declined to participate and 19 were excluded from the study (Fig. 1). Thus, 69 persons consented to participate in the study and completed the baseline research assessment. There was no difference between research participants and those who declined to participate in the research, respectively, in age (77.8 ± 8.9 years versus 80.6 ± 6.8 years; t = 1.7, df = 104, p = 0.09)

Discussion

In keeping with the known associations between falls, fear of falling, and depression,5 51% of participants had moderate or severe fear of falling and 30% had a DSM-IV depressive disorder. Not all persons in the depressed group had major depression, but other types of depressive disorder such as minor depression are nevertheless clinically significant, with disability and outcomes that are intermediate between those of major depression and no depression.35, 36 Consistent with previous studies,5

Conclusion

To conclude, we found a high frequency of depressive disorders among persons attending an FPP, but depression did not impede improvement in fear of falling. In fact, depressed individuals who experienced improvement in depressive symptoms while attending the FPP also experienced improvement in falls efficacy. This raises the question as to whether a cognitive-behavioral intervention that simultaneously targets both depression and falls efficacy would be a useful component of a FPP.

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