@article {11755, title = {The role of frailty in the association between depression and fall risk among older adults}, journal = {Aging \& Mental Health}, volume = {26}, year = {2022}, pages = {1805-1812}, 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}, isbn = {1360-7863}, doi = {10.1080/13607863.2021.1950616}, author = {Matthew C. Lohman and Briana Mezuk and Amanda J Fairchild and Nicholas V Resciniti and Anwar T Merchant} } @article {11120, title = {Antidepressant Use Partially Mediates the Association Between Depression and Risk of Falls and Fall Injuries Among Older Adults.}, journal = {The Journals of Gerontology: Series A }, volume = {76}, year = {2021}, pages = {e171}, abstract = {

BACKGROUND: The association between depression and fall risk in older adults is recognized, yet the mechanisms underlying this association are unclear. This study estimated the mediating role of antidepressant use in the association between depression and falls and fall injuries.

METHODS: Longitudinal data from the Health and Retirement Study (HRS; 2004-2006) were linked with medication data from the Prescription Drug Study (PDS; 2005). The sample included community-dwelling adults age >= 65 with data on depression and medication use (n=3,565). Depression was measured using two independent survey tools: Composite International Diagnostic Interview for depression short form and an 8-item version of the Centers for Epidemiologic Studies Depression scale. We used causal mediation analysis to estimate and compare the direct and indirect (mediated by antidepressant use) effects of depression on falls and fall injuries.

RESULTS: Individuals with major depressive disorder (MDD) were significantly more likely to experience a fall (OR: 1.92; 95\% CI: 1.41, 2.62) and a fall injury (OR: 1.67; 95\% CI: 1.09, 2.55) over two years. Indirect effect estimates showed that antidepressant medication use accounted for approximately 19\% and 18\% of the association between MDD and falls and fall injuries, respectively. Results were similar when using an alternative depression measure and when considering only selective serotonin reuptake inhibitor antidepressants.

CONCLUSION: Antidepressant use explains a significant proportion, but not a majority, of the association between depression and greater fall risk. Treatment benefits of antidepressants should be considered with, and may outweigh, concerns about increased risk of falls associated with antidepressant use.

}, keywords = {Causal mediation analysis, Epidemiology, falls and mobility problems}, issn = {1758-535X}, doi = {10.1093/gerona/glaa253}, author = {Matthew C. Lohman and Amanda J Fairchild and Anwar T Merchant} }