Depression: a modifiable factor in fearful older fallers transitioning to frailty?

ABSTRACT

OBJECTIVE: Fear of falling is one of the most common fears among community-dwelling older people and is as serious a health problem as falls themselves. Understanding fear of falling in fallers transitioning to frailty may help us identify effective strategies to reduce it in this already vulnerable group of older people. Our aim was to evaluate the psychological factors associated with fear of falling in a group of fallers transitioning to frailty when compared with robust or non-frail fallers. METHODS: Cross-sectional design where 301 fallers underwent assessment at the Technology Research for Independent Living Clinic in Dublin (http//www.trilcentre.org/) is seen. Fear of falling was measured using the Modified Falls Efficacy Scale, and frailty was measured using the Biological Syndrome Model. Psychological measures included assessment of anxiety, depression, loneliness, personality factors and cognition. RESULTS: Frailer fallers had increased fear of falling when compared with robust fallers (p < 0.001). Age, female gender and lower cognitive scores were associated with greater fear of falling in the robust group. For frailer fallers, higher depression score was the only factor associated with fear of falling on multivariate analysis. The odds ratio of having case level depressive disorder (CESD-8 ≥ 4) if you were a frailer faller was significantly higher than if you were robust (OR = 2.6, CI 1.3-5.2, p = 0.006). CONCLUSION: Fallers at a transitional level of frailty may represent a particularly vulnerable group psychologically who would benefit most from interventional strategies with specific intervention components addressing depressive symptoms.