Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-08T03:27:37.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Falls in older adults with major depressive disorder (MDD): a systematic review and exploratory meta-analysis of prospective studies

Published online by Cambridge University Press:  03 August 2015

Brendon Stubbs ,
Jean Stubbs ,
Solomon Donald Gnanaraj  and
Andrew Soundy
Brendon Stubbs*
Affiliation:
Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, Box SE5 8AF, UK Physiotherapy department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
Jean Stubbs
Affiliation:
Research Associate, St Andrews Healthcare, Northampton, NN1 5DG, UK
Solomon Donald Gnanaraj
Affiliation:
Physiotherapy department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
Andrew Soundy
Affiliation:
Department of Physiotherapy, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
*
Correspondence should be addressed to: Brendon Stubbs, Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK. Phone: +4420832283877; Fax: +442032282702. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Depressive symptomology is now widely recognized as a key risk factor for falls. The evidence regarding the impact of major depressive disorder (MDD) on falls is unclear. A systematic review and exploratory meta-analysis was undertaken to explore the relationship between MDD and falls.

Methods:

Major electronic database were searched from inception till April 2015. Studies that defined MDD and measured falls prospectively in older adults (≥60 years) were included. Studies relying on depressive symptomology alone were excluded. The methodological quality of included articles was assessed and study findings were synthesized using an exploratory meta-analysis.

Results:

From a potential of 415 articles, only three studies met the inclusion criteria. This included 976 unique older adults with a range of mean age from ≥65 to 83 years. The methodological quality of included studies was satisfactory. None of the included studies’ primary aim was to investigate the relationship between MDD and falls. The exploratory meta-analysis demonstrated older adults with MDD are at increased risk of falling compared to non-depressed older adults (odds ratio (OR) 4.0, 95% CI 2.0–8.1, I2 = 60%, n = 976).

Conclusion:

There is a paucity of research considering falls in older adults with MDD. Our results demonstrate that the odds of falling appear to be greater among people with MDD (OR 4.0) than in previous meta-analyses that have only considered subthreshold depressive symptoms. Given the distinct nature and challenges with MDD, more research is required to better understand the falls risk in this group.

Keywords

fallsmajor depressive disordermajor depression
Type
Review Article
Information
International Psychogeriatrics , Volume 28 , Issue 1 , January 2016 , pp. 23 - 29
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Begg, C. B. and Mazumdar, M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088–1101.Google Scholar
Bridle, C., Spanjers, K., Patel, S., Atherton, N. M. and Lamb, S. E. (2012). Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. The British Journal Of Psychiatry: The Journal Of Mental Science, 201, 180–185.Google Scholar
Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., La Vecchia, C. and Negri, E. (2010). Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology (Cambridge, Mass.), 21, 658–668.Google Scholar
Denkinger, M. D., Lukas, A., Nikolaus, T., Peter, R. and Franke, S. (2014). Multisite pain, pain frequency and pain severity are associated with depression in older adults: results from the ActiFE Ulm study. Age And Ageing, 43, 510–514.CrossRefGoogle ScholarPubMed
Egger, M., Davey Smith, G., Schneider, M. and Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research Ed.), 315, 629–634.Google Scholar
Eggermont, L. H. P., Penninx, B. W. J. H., Jones, R. N. and Leveille, S. G. (2012). Depressive symptoms, chronic pain, and falls in older community-dwelling adults: the MOBILIZE Boston study. Journal of the American Geriatrics Society, 60, 230–237.Google Scholar
Fiske, A., Wetherell, J. L. and Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363–389.CrossRefGoogle ScholarPubMed
Gaßmann, K. G., Rupprecht, R. and Freiberger, E. (2009). Predictors for occasional and recurrent falls in community-dwelling older people. Zeitschrift für Gerontologie und Geriatrie, 42, 3–10.CrossRefGoogle ScholarPubMed
Gebara, M. A., Lipsey, K. L., Karp, J. F., Nash, M. C., Iaboni, A. and Lenze, E. J. (in press). Cause or effect? Selective serotonin reuptake inhibitors and falls in older adults: a systematic review. The American Journal of Geriatric Psychiatry: Official Journal Of The American Association For Geriatric Psychiatry.Google Scholar
Gillespie, L. D. et al. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD005465.pub3 Google Scholar
Granek, E. et al. (1987). Medications and diagnoses in relation to falls in a long-term care facility. Journal Of The American Geriatrics Society, 35, 503–511.Google Scholar
Hull, S. L., Kneebone, I. I. and Farquharson, L. (2013). Anxiety, depression, and fall-related psychological concerns in community-dwelling older people. The American Journal of Geriatric Psychiatry, 21, 1287–1291.Google Scholar
Iaboni, A. and Flint, A. J. (2013). The complex interplay of depression and falls in older adults: a clinical review. The American Journal of Geriatric Psychiatry, 21, 484–492.Google Scholar
Kessler, R. C. et al. (2003). The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R). JAMA, 289, 3095–3105.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Kvelde, T. et al. (2013). Depressive symptomatology as a risk factor for falls in older people: systematic review and meta-analysis. Journal of the American Geriatrics Society, 61, 694–706.Google Scholar
Lamb, S. E., Jørstad-Stein, E. C., Hauer, K. and Becker, C. (2005). Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. Journal of the American Geriatrics Society, 53, 1618–1622.Google Scholar
Launay, C., De Decker, L., Annweiler, C., Kabeshova, A., Fantino, B. and Beauchet, O. (2013). Association of depressive symptoms with recurrent falls: a cross-sectional elderly population based study and a systematic review. The Journal Of Nutrition, Health & Aging, 17, 152–157.Google Scholar
Leveille, S. G., Bean, J., Ngo, L., McMullen, W. and Guralnik, J. M. (2007). The pathway from musculoskeletal pain to mobility difficulty in older disabled women. Pain(03043959), 128, 69–77.Google Scholar
Mitchell, A. J., Vaze, A. and Rao, S. (2009). Clinical diagnosis of depression in primary care: a meta-analysis. Lancet, 374, 609–619.Google Scholar
Moher, D., Liberati, A., Tetzlaff, J. and Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Clinical Trials, 6, 1–6.Google Scholar
Murray, C. J. et al. (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 2197–2223.Google Scholar
Naci, H. and Ioannidis, J. P. A. (2013). Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ (Clinical Research Ed.), 347, f5577.Google Scholar
Olfson, M. and Marcus, S. C. (2009). National patterns in antidepressant medication treatment. Archives General Psychiatry, 66, 848–856. doi: 10.1001/archgenpsychiatry.2009.81.CrossRefGoogle ScholarPubMed
Quach, L. et al. (2013). Depression, antidepressants, and falls among community-dwelling elderly people: the MOBILIZE Boston study. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 68, 1575–1581.Google Scholar
Rodda, J., Walker, Z. and Carter, J. (2011). Depression in older adults. BMJ (Overseas & Retired Doctors Edition), 343, 683–687.Google Scholar
Rosendahl, E., Lundin-Olsson, L., Kallin, K., Jensen, J., Gustafson, Y. and Nyberg, L. (2003). Prediction of falls among older people in residential care facilities by the Downton index. Aging Clinical And Experimental Research, 15, 142–147.Google Scholar
Stroup, D. F. et al. (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA, 283, 2008–2012.Google Scholar
Stubbs, B. (in press). A meta analysis in falls in older adults taking selective seretonin reuptake inhibitors confirms an association but by no means but by no means implies causation. American Journal of Geriatric Psychiatry.Google Scholar
Stubbs, B., Binnekade, T., Eggermont, L., Sepehry, A. A., Patchay, S. and Schofield, P. (2014). Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Archives of Physical Medicine & Rehabilitation, 95, 175–187.e179.CrossRefGoogle ScholarPubMed
Stubbs, B., Brefka, S., Dallmeier, D., Vancampfort, D. and Denkinger, M. D. (submitted). Reduced bone mineral density at the hip but not lumbar spine is evident among older adults with depressive symptoms: a comparative meta-analysis.Google Scholar
Stubbs, B., Brefka, S. and Denkinger, M. (2015). What works to prevent falls in community dwelling older adults? An umbrella review of meta-analyses of randomised controlled trials. Physical Therapy.Google Scholar
Tak, E., Kuiper, R., Chorus, A. and Hopman-Rock, M. (2013). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing research reviews, 12, 329–338.Google Scholar
Vancampfort, D. et al. (2013). The importance of self-determined motivation towards physical activity in patients with schizophrenia. Psychiatry Research, 210, 812–818.Google Scholar
Wells, G., Shea, B., O’Connell, D. and Peterson, J. (2010). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp; last accessed 20 July 2015.Google Scholar
Woolcott, J. C. et al. (2009). Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of Internal Medicine, 169, 1952–1960.Google Scholar