The role of frailty in the association between depression and fall risk among older adults

Abstract

Objectives

Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression.

Method

We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010–2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls.

Results

Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression.

Conclusion

Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.

Keywords:

• Causal mediation analysis
• epidemiology
• falls and mobility problems

Disclosure statement

The authors report no potential conflicts of interest.

Author contributions

M.L. contributed to the conception of the study, the analysis and interpretation of data, and the drafting and revision of the manuscript. B.M. contributed to the interpretation of data and the drafting and revision of the manuscript. A.F. contributed to the analysis and interpretation of data and the drafting and revision of the manuscript. N.R. contributed to the interpretation of data and the drafting and revision of the manuscript. A.M. contributed to the analysis and interpretation of data and the drafting and revision of the manuscript.

Additional information

Funding

This work was supported by a grant from the National Institute on Aging at the National Institutes of Health (grant number R21AG064310).