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Understanding temporal relationships between depression, falls, and physical activity in a cohort of post-hospitalized older adults – a breakthrough or a conundrum?

Published online by Cambridge University Press:  19 June 2017

Den-Ching A. Lee ,
Aislinn F. Lalor ,
Grant Russell ,
Rene Stolwyk ,
Ted Brown ,
Fiona McDermott  and
Terry P. Haines
Den-Ching A. Lee*
Affiliation:
Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), McMahons Road, Frankston, Victoria 3199, Australia
Aislinn F. Lalor
Affiliation:
Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), McMahons Road, Frankston, Victoria 3199, Australia
Grant Russell
Affiliation:
Head of School of Primary and Allied Health Care and Director of Southern Academic Primary Health Care Research Unit, Department of General Practice, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Notting Hill Campus), Building 1, 270 Ferntree Gully Road, Notting Hill Victoria 3168, Australia
Rene Stolwyk
Affiliation:
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Clayton Campus), Wellington Road, Clayton, Victoria 3800, Australia
Ted Brown
Affiliation:
Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University (Peninsula Campus), McMahons Road, Frankston, Victoria 3199, Australia
Fiona McDermott
Affiliation:
Department of Social Work, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University (Caulfield Campus), 900 Dandenong Road, Caulfield East, Victoria 3145, Australia
Terry P. Haines
Affiliation:
Director of Allied Health Research Unit, Monash Health and Director of Research, Southern Physiotherapy Clinical School, Physiotherapy Department, Monash University (Peninsula Campus), McMahons Road, Frankston, Victoria 3199, Australia
*
Correspondence should be addressed to: Dr Den-Ching A. Lee, Allied Health Research Unit, Kingston Centre, Monash Health, Cnr Heatherton and Warrigal Road, Cheltenham, Victoria 3192, Australia. Phone: +61421 136 625. Email: angel.lee1@monash.edu.
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Abstract

Background:

Clinical depression affects approximately 15% of community-dwelling older adults, of which half of these cases present in later life. Falls and depressive symptoms are thought to co-exist, while physical activity may protect an older adult from developing depressive symptoms. This study investigates the temporal relationships between depressive symptoms, falls, and participation in physical activities amongst older adults recently discharged following extended hospitalization.

Methods:

A prospective cohort study in which 311 older adults surveyed prior to hospital discharge were assessed monthly post-discharge for six months. N = 218 completed the six-month follow-up. Participants were recruited from hospitals in Melbourne, Australia. The survey instrument used was designed based on Fiske's behavioral model depicting onset and maintenance of depression. The baseline survey collected data on self-reported falls, physical activity levels, and depressive symptoms. The monthly follow-up surveys repeated measurement of these outcomes.

Results:

At any assessment point, falls were positively associated with depressive symptoms; depressive symptoms were negatively associated with physical activity levels; and, physical activity levels were negatively associated with falls. When compared with data in the subsequent assessment point, depressive symptoms were positively associated with falls reported over the next month (unadjusted OR: 1.20 (1.12, 1.28)), and physical activity levels were negatively associated with falls reported over the next month (unadjusted OR: 0.97 (0.96, 0.99) household and recreational), both indicating a temporal relationship.

Conclusion:

Falls, physical activity, and depressive symptoms were inter-associated, and depressive symptoms and low physical activity levels preceded falls. Clear strategies for management of these interconnected problems remain elusive.

Keywords

depressionphysical activityfallsolder adultstemporaldischargehospitalassociated
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 10 , October 2017 , pp. 1681 - 1692
Copyright
Copyright © International Psychogeriatric Association 2017 

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