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Depressive Symptoms and Orthostatic Hypotension Are Risk Factors for Unexplained Falls in Community‐Living Older People
Author(s) -
Menant Jasmine C.,
Wong Alfred K. W.,
Trollor Julian N.,
Close Jacqueline C. T.,
Lord Stephen R.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14104
Subject(s) - medicine , orthostatic vital signs , depression (economics) , population , prospective cohort study , physical therapy , mood , poison control , cohort , logistic regression , presyncope , psychiatry , blood pressure , emergency medicine , heart rate , environmental health , economics , macroeconomics
Objectives To investigate risk factors for unexplained falls in older community‐dwelling individuals. Design Prospective cohort study. Setting Community population, Sydney, Australia. Participants Older adults (N = 529; mean age 79.8 ± 4.4, 52.2% female). Measurements Participants provided information demographic, medical, and medication characteristics and completed cardiovascular (tilt table test, pulse wave velocity), cognitive, and sensorimotor assessments at baseline. Falls were then recorded in monthly fall diaries for 12 months. Unexplained fallers ( UF s) were those who reported falls due to a blackout, dizziness, feeling faint, or “found themselves suddenly on the ground.” Results Of the 523 participants available at follow‐up, 238 (45.5%) reported one or more falls; 35 participants fulfilled the definition of UF s. UF s were more likely than balance‐related fallers ( BF s) (n = 203) and nonfallers (n = 291) to have orthostatic hypotension (39.4%, 20.5% and 22.4%, respectively) and depressive symptoms (24.2%, 10.1%, and 7.9% respectively). More UF s (88.6%) than BF s (70.9%) had injurious falls. A multivariate logistic regression model revealed that depressive symptoms and orthostatic hypotension were significant and independent determinants of UF status. Conclusion Approximately 15% of fallers had unexplained falls, which were more likely to result in injuries. Depressive symptoms and orthostatic hypotension increased the risk of unexplained falls, whereas cognitive deficits and sensorimotor and balance impairments did not. Future research should investigate whether psychotherapy and physical exercise to improve mood and medication reviews and nonpharmacological therapies for the treatment of orthostatic hypotension and depression are effective at reducing the risk of unexplained falls in older people.