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

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.

Frailty, depression, and anxiety in later life.

BACKGROUND: Anxiety and depression are common in older people but are often missed; to improve detection we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and depression in later life. METHODS: This study had a cross-sectional design and involved the assessment of 567 community-dwelling people aged ≥ 60 years recruited from the Technology Research for Independent Living (TRIL) Clinic, Dublin. Frailty was measured using the Fried biological syndrome model; depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale; and anxiety symptoms measured using the Hospital Anxiety and Depression Scale. RESULTS: Higher depression and anxiety scores were identified in both pre-frail and frail groups compared to robust elders (three-way factorial ANOVA, p ≤ 0.0001). In a logistic regression model the odds ratio for frailty showed a significantly higher likelihood of clinically meaningful depressive and anxiety symptoms even controlling for age, gender and a history of depression or anxiety requiring pharmacotherapy (OR = 4.3; 95% CI 1.5, 11.9; p = 0.005; OR = 4.36; 95% CI 1.4, 13.8; p = 0.013 respectively). CONCLUSIONS: Our findings suggest that even at the earliest stage of pre-frailty, there is an association with increased symptoms of emotional distress; once frailty develops there is a higher likelihood of clinically significant depression and anxiety. Frailty may be relevant in identifying older people at risk of deteriorating mental health.

Subjective well-being amongst community-dwelling elders: what determines satisfaction with life? Findings from the Dublin Healthy Aging Study.

BACKGROUND: Life satisfaction is a subjective expression of well-being and successful aging. Subjective well-being is a major determinant of health outcomes in older people. The aim of this study was to determine which factors predicted well-being in older people living in the community as measured by their satisfaction with life. METHODS: The relationship between life satisfaction, as measured by the Life Satisfaction Index (LSI-A) and physical, cognitive and demographic variables was examined in 466 older people living in the community using a stepwise regression model. RESULTS: Depression, loneliness, neuroticism, extraversion, recent participation in physical activity, age and self-reported exhaustion, were the independent predictors of life satisfaction in our elderly cohort. CONCLUSION: Subjective well-being, as measured by the Life Satisfaction Scale, is predicted by depression, loneliness, personality traits, recent participation in physical activity and self-reported exhaustion. The mental and emotional status of older individuals, as well as their engagement in physical activity, are as important as physical functionality when it comes to life satisfaction as a measure of well-being and successful aging. These areas represent key targets for intervention.

The management and functional outcome of isolated burst fractures of the fifth lumbar vertebra.

STUDY DESIGN: We retrospectively reviewed 14 cases of isolated burst fractures of the fifth lumbar vertebra (L5) presenting over a 10-year period to the National Spinal Injuries Unit (NSIU) of the Republic of Ireland. OBJECTIVES: The objective was to evaluate treatment outcomes in patients suffering isolated burst fractures of L5 without neurologic compromise managed operatively and nonoperatively. SUMMARY OF BACKGROUND DATA: Burst fractures of L5 represent a very small proportion of all spinal injuries. The unique anatomic and biomechanical characteristics of this region protect it from traumatic injury. METHODS: Fourteen patients (n = 14) were managed for isolated burst fractures of L5 at the NSIU over a 10-year period. The Hospital Inpatient Enquiry System and the NSIU Database identified our study cohort. A retrospective analysis of the medical records, radiographs, and CT scans of all patients identified was performed. Loss of anterior vertebral height, degree of kyphotic deformity, and percentage retropulsion were recorded at several phases of treatment. Follow-up clinical evaluation was performed with respect to pain status, work and recreational restrictions, along with overall patient satisfaction. RESULTS: Of the study cohort (n = 14), 10 patients were managed nonoperatively and 4 patients operatively. The nonoperative group showed a superior radiographic outcome at follow-up, with the nonoperative group showing a mean loss of anterior vertebral height of 15.7% and a mean kyphotic deformity of 10.4 degrees. The operative group, in contrast, had a mean loss of anterior vertebral height of 19% and mean kyphotic deformity of 11 degrees at follow-up. The nonoperative group additionally exhibited superior results at clinical follow-up regarding pain status, work and recreational restrictions, and overall satisfaction. CONCLUSIONS: In the largest series to date of isolated burst fractures of L5, we strongly advocate the nonoperative management of these injuries, particularly in cases of moderate bony deformity, minimal canal compromise, and no neurologic deficit.