scholarly journals Disentangling and Quantifying Mechanisms of Increased Fall Risk Among Older Adults With Depression

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 266-266
Author(s):  
Matthew Lohman ◽  
Nicholas Resciniti ◽  
Anwar Merchant
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Relative Strength ◽  
Drug Study ◽  
Injurious Falls ◽  
Mediating Mechanisms ◽  
Causal Mediation Analysis ◽  
Significant Mediator

Abstract Background: Older adults with depression are up to four times more likely to fall, yet the mechanisms by which depression increases fall risk are unclear. This study sought to quantify and compare the relative strength of selected mechanisms mediating the association between depression and falls. Methods: We used longitudinal linked data (2006 – 2010) from the Health and Retirement Study and Prescription Drug Study. The analytic sample included non-institutionalized adults age > 65 with data on physical functioning and medication use (n=3,565). Falls and injurious falls over the past two years were self-reported outcomes. Depression was measured using the Composite International Diagnostic Interview (CIDI). We used causal mediation analysis to estimate the total and direct associations between depression and falls and compared strength of three potential mediating mechanisms – frailty, cognition, and antidepressant (AD) use. Results: Of 190 participants reporting depression in 2006, 85 (44.7%) fell and 30 (15.8%) were injured from a fall between 2008 and 2010. Depressed individuals were 92% more likely to fall compared to non-depressed (OR=1.92, p<.01). We found significant indirect effects of AD use (indirect OR=1.17, p<.01) and frailty (OR=1.12, p=.013) representing 19% and 13% of the total effect of depression on falls, respectively. Cognition was not a significant mediator. Results were similar for falls leading to injury. Discussion: Results suggest that AD use and frailty explain a significant portion of the elevated risk for falls among depressed individuals. Identification of these and other mechanisms may inform clinical treatment decisions for older adults with depression.

scholarly journals Food Insecurity and Geriatric Hospitalization

2019 ◽  
Vol 16 (13) ◽  
pp. 2294
Author(s):  
Rachel S. Bergmans ◽  
Briana Mezuk ◽  
Kara Zivin
Keyword(s):  
Older Adults ◽  
Best Practices ◽  
Food Insecurity ◽  
Short Form ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Increased Risk ◽  
Bidirectional Relationship ◽  
Longitudinal Associations ◽  
Retirement Study

Food insecurity (FI) has been associated with hospitalization, although the pathways underlying this relationship are poorly understood, in part due to the potential for a bidirectional relationship. This study aimed to determine associations of FI with concurrent and future hospitalization among older adults; mediation by depression and; whether hospitalization increased risk of FI. Participants came from the 2012 and 2014 waves of the Health and Retirement Study (HRS; n = 13,664). HRS is a prospective cohort representative of U.S. adults over the age of 50. Primary analyses included those who were not hospitalized in 2012 (n = 11,776). Not having enough money to buy necessary food or eating less than desired defined food insecurity. The Composite International Diagnostic Interview Short Form provided depression symptomology. Logistic and linear regression examined concurrent and longitudinal associations of FI in 2012 and 2014 with hospitalization in 2014. Path analysis tested mediation of FI with hospitalization frequency by depression symptomology. Finally, logistic regression examined whether hospitalization in 2012 was longitudinally associated with FI in 2014. FI was not associated with future hospitalization (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 0.9–1.4), however; FI was associated with concurrent hospitalization status (OR = 1.4; 95% CI = 1.1–1.8). Depression symptomology explained 17.4% (95% CI = 2.8–32.0%) the association of FI with concurrent hospitalization frequency. Additionally, hospitalization was associated with becoming food insecure (OR = 1.5; 95% CI = 1.2–2.0). Findings may inform best practices for hospital discharge among older adults.

scholarly journals Prospective Associations between Religiousness/Spirituality and Depression and Mediating Effects of Forgiveness in a Nationally Representative Sample of United States Adults

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Loren L. Toussaint ◽  
Justin C. Marschall ◽  
David R. Williams
Keyword(s):  
United States ◽  
Representative Sample ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Protective Effects ◽  
Indirect Path ◽  
Salutary Effect ◽  
Mediating Mechanisms ◽  
Nationally Representative ◽  
Forgiveness Of Others

The present investigation examines the prospective associations of religiousness/spirituality with depression and the extent to which various dimensions of forgiveness act as mediating mechanisms of these associations. Data are from a nationally representative sample of United States adults who were first interviewed in 1998 and reinterviewed six months later. Measures of religiousness/spirituality, forgiveness, and various sociodemographics were collected. Depression was assessed using the Composite International Diagnostic Interview administered by trained interviewers. Results showed that religiousness/spirituality, forgiveness of oneself and others, and feeling forgiven by God were associated, both cross-sectionally and longitudinally, with depressive status. After controlling for initial depressive status, only forgiveness of oneself and others remained statistically significant predictors of depression. Path analyses revealed that religiousness/spirituality conveyed protective effects, prospectively, on depression by way of an indirect path through forgiveness of others but not forgiveness of oneself. Hence, forgiveness of others acts as a mechanism of the salutary effect of religiousness/spirituality, but forgiveness of oneself is an independent predictor. Conclusions regarding the continued development of this type of research and for the treatment of clients with depression are offered.

Unterschiede in der Mutter-Kind-Bindung bei Frauen mit und ohne Soziale Phobie

2017 ◽  
Vol 45 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Ariane Kraft ◽  
Susanne Knappe ◽  
Katja Petrowski ◽  
Johanna Petzoldt ◽  
Julia Martini
Keyword(s):  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Kindliche Entwicklung ◽  
Soziale Phobie

Zusammenfassung. Fragestellung: Untersuchung der Bedeutung von mütterlicher Sozialer Phobie für die Entwicklung der Mutter-Kind-Beziehung in einer prospektiv-longitudinalen Studie. Methodik: Eine Teilstichprobe von 46 Frauen mit vs. ohne Lebenszeitdiagnose einer Sozialen Phobie und deren Kindern wurde analysiert. Soziale Phobien der Mütter wurden mit dem Composite International Diagnostic Interview für Frauen (CIDI-V) erhoben. Die Mütter wurden zum ante- und postnatalen Bonding befragt (MAAS, MPAS) und die Kinder wurden 16 Monate nach der Geburt mit dem Fremde-Situations-Test beobachtet. Ergebnisse: Kinder von sozialphobischen Müttern waren in der Verhaltensbeobachtung prozentual häufiger unsicher gebunden (45.4 % vs. 33.3 %) und brauchten signifikant länger, um den Kontakt zur Mutter in der Wiedervereinigungsphase wiederherzustellen (U = 160.0, p = .019). In Bezug auf das ante- (t = -.151, p = .881) und postnatale (t = .408, p = .685) Bonding der Mutter an das Kind sowie im widerstehenden (U = 262.5, p = .969), vermeidenden (U = 311.5, p = .258) und kontakterhaltenden (U = 224.0, p = .373) Verhalten des Kindes in der Fremden Situation zeigten beide Gruppen vergleichbare Werte. Schlussfolgerungen: Möglicherweise haben Mütter mit Sozialer Phobie eine gehemmte Verhaltensdisposition weitergegeben oder ihre Kinder weniger zur sozialen Interaktion ermutigt als Mütter ohne Soziale Phobie. Wenn Kinder von sozialphobischen Müttern Interaktionsängste zeigen, sollte eine Aufklärung über verschiedene Therapiemöglichkeiten sowie über mögliche Konsequenzen des eigenen (Vermeidungs-)Verhaltens für die kindliche Entwicklung erfolgen.

Protective Factors and Suicidality in Members of Arab Kindred

Crisis ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 80-86 ◽  
Author(s):  
Sami Hamdan ◽  
Nadine Melhem ◽  
Israel Orbach ◽  
Ilana Farbstein ◽  
Mohammad El-Haib ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Suicidal Behavior ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Suicidal Risk ◽  
Arab Population ◽  
Psychiatric Interview ◽  
History Of

Background: Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors. Aims: To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors. Methods: We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale. Results: Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2 = 11.17, p = .001), an anxiety disorder (87.5% vs. 22.9, χ2 = 21.02, p < .001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher’s, p = .003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31 ± 1.36 vs. 4.96 ± 1.40, t = 4.10, df = 62, p < .001), and they have the view that suicide is somehow unacceptable (1.83 ± .10 vs. 1.89 ± .07, t = 2.76, df = 60, p = .008). Conclusions: Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

The Relationship Between Fear of Falling and Functional Fitness among Older Adults Living in Rest Home

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
H Tuna ◽  
Ö Bozan ◽  
B Gürpınar ◽  
N İlçin
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Dynamic Balance ◽  
Upper Body ◽  
Functional Fitness ◽  
Fall Risk Factors ◽  
Rest Home ◽  
History Of

Objective: This study aimed to report the fear of falling and assess its associations with several fall-related characteristics and functional fitness parameters among older adults living in the rest home. Methods: Seventy-eight older adults aged between 65-94 years were included in the study. History of falling and the number of risk factors for falling were recorded. Fear of falling was evaluated with The Falls Efficacy ScaleInternational. Functional fitness was assessed with Senior Fitness Test, including tests for the functional measurement of strength, flexibility, aerobic endurance and dynamic balance. Result: The mean age of participants was 78.46±7.16 years. There were correlations exist between fear of falling and number of fall risk factors, dynamic balance, upper body flexibility and aerobic endurance (p<0.05). Multiple linear regression analysis showed that the parameters with the highest determinants of fear of falling were the dynamic balance and history of falling (p<0.05). Conclusions: In our study, history of falling, number of fall risk factors, flexibility for the upper body, aerobic endurance and dynamic balance were parameters related to fear of falling among older adults, but the most influential factors in fear of falling were dynamic balance and history of falling.

scholarly journals Perceptions of Care Among Older Adults Identified as Fall Risk During a Hospital Stay

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 139-139
Author(s):  
Barbara King
Keyword(s):  
Older Adults ◽  
Hospital Stay ◽  
Older Adult ◽  
Fall Prevention ◽  
Fall Risk ◽  
Medical Center ◽  
Academic Medical Center ◽  
Common Strategy ◽  
Open Coding ◽  
Perceptions Of Care

Abstract In-hospital falls are a significant clinical, legal and regulatory problem. The Centers for Medicare and Medicaid no longer reimburse hospitals for falls that result in injury, adding increase pressure on acute care settings to prevent falls. Additionally, evidence-based practice recommendations for fall prevention in hospitals do not exist, thus leaving administrators to create their own programs. One common strategy used by hospital providers to prevent falls is to restrict patient mobility. Little information on how older adult patients experience fall prevention during a hospital stay has been published. The purpose of this study was to understand perceptions of care among older adults identified as fall risk during a hospital stay. This qualitative study utilized inductive content analysis. Older adults (N=20) from a large academic medical center in the Midwest were recruited to participate in one-to one in-depth interviews. Open coding, categorization and abstraction was used to analyze the data. Three main categories were identified that summarized the older adult patient perception of hospitalization: Act of Caring, something they received from staff, provide to staff or provided to self; Being Restricted in movement resulting in either accepting or rejecting the restriction and Being Freed at discharge, often being told “just be careful”. Older adult identified as fall risk described being restricted in movement during a hospital stay. Many passively accepted this restriction even though they felt a lack of movement would be harmful to them. Additional research on the patient experience with fall prevention is needed.

scholarly journals Student-Led Fall Prevention Care Management Reduced Fall Risks at Assisted Living Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 238-238
Author(s):  
Hiroko Kiyoshi-Teo ◽  
Claire McKinley-Yoder ◽  
Erin Lemon ◽  
Olivia Ochoa
Keyword(s):  
Older Adults ◽  
Assisted Living ◽  
Fall Prevention ◽  
Fall Risk ◽  
Care Management ◽  
Assisted Living Facilities ◽  
Care Needs ◽  
Term Care ◽  
Fall Risks ◽  
The Impact

Abstract Older adults in residential care settings are four times more likely than those not living in care facilities to experience falls. Yet, fall prevention efforts at long-term care settings are under-resourced, under-regulated, and under-studied. To address this gap, we developed and studied the impact of a specialty clinical, Fall Prevention Care Management (FPCM), for nursing students to decrease older adults’ fall risks. We enrolled assisted living residents that facility liaison identified as being high fall risk (fall rates or fall risk were not tracked at the study sites) and MOCA ≥15, in 2 assisted living facilities in Northwest USA. Participants received weekly, 1-hour, individual, semi-structured, Motivational Interviewing-based care management visits by same students over 6 visits. Changes in fall risks were measured by the CDC STEADI assessment (unsteadiness & worry), Falls Self-Efficacy Scale International-Short (FESI-S), and Falls Behavioral Scale (FAB). Twenty-five residents completed the study. Students addressed the following (multiple responses possible): emotional needs (n=23), improved motivation to prevent falls (n=21), and individualized education/coaching (i.e., exercise, mobility aids) (n=10-17). FESI-S score improved from 16.0 to 14.4 (p=.001; decreased fear. FAB score improved from 2.94 to 3.10 (p=.05; more frequent fall prevention behaviors). Frequency of those who felt steady while standing or walking increased (24% to 40%, p=.07) and those who did not worry about falling increased (20% to 36%, p=.08). FPCM clinical offered valuable opportunity to address unmet care needs of older adults to reduce fall risks.

scholarly journals Toe Clearance Rehabilitative Slippers for Older Adults With Fall Risk: A Randomized Controlled Trial

2021 ◽  
Vol 12 ◽  
pp. 215145932110291
Author(s):  
Atsuko Satoh ◽  
Yukoh Kudoh ◽  
Sangun Lee ◽  
Masumi Saitoh ◽  
Miwa Miura ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Controlled Trial ◽  
Intervention Group ◽  
Berg Balance Scale ◽  
Control Group ◽  
Mobility Assessment ◽  
Before And After ◽  
Day Services ◽  
And Control

Introduction: To evaluate fall-prevention rehabilitative slippers for use by self-caring, independent older adults. Materials and Methods: This assessor-blinded, randomized, and controlled 1-year study included 59 self-caring, independent participants (49 women) who attended day services. The mean age of participants was 84.0 ± 5.3 years. Participants were randomly selected from 8 nursing homes. We tested slippers top-weighted with a lead bead (200, 300, or 400 g). Intervention group participants walked while wearing the slippers for 10-20 min, 1-3 days/week at the day service center. Fall risk was measured using the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment (POMA) before and at 3-month intervals after the intervention/control phase. Results: After 12 months, the intervention group demonstrated significant improvement. Berg Balance and POMA compared to the control group ( p < .05 p < .01, respectively). Mobility scores improved significantly for both measurements in the intervention group before and after ( p < .01), but the control group had significantly lower scores. Discussion: Overall, falls decreased in the intervention group from 10 to 7, and control group falls increased from 9 to 16 ( p = .02). No adverse events related to the intervention were reported. Conclusions: Rehabilitation training slippers may reduce falls in older adults.

Subjective Evaluation of Balance by the Dizziness Handicap Inventory Does Not Predict Fall Risk in Older Adults Visiting Otolaryngology Clinics

2021 ◽  
pp. 000348942098797
Author(s):  
Iku Abe-Fujisawa ◽  
Yukihide Maeda ◽  
Soshi Takao ◽  
Shin Kariya ◽  
Kazunori Nishizaki
Keyword(s):  
Older Adults ◽  
Postural Balance ◽  
Fall Risk ◽  
Spontaneous Nystagmus ◽  
Anxiety And Depression ◽  
Published Data ◽  
Objective Data ◽  
Subjective Symptoms ◽  
Characteristic Analysis ◽  
Dizziness Handicap Inventory

Objectives: Subjective symptoms of dizziness in older adults are affected not only by objective data such as postural balance, but also by complex psychological factors. Published data analyzing how simultaneous evaluations of both objective and subjective assessments of balance can predict fall risk remain lacking. This study examined how fall risk can be predicted based on both objective data for balance and hearing and subjective symptoms of dizziness among older adults visiting otolaryngology clinics. Methods: Medical charts of 76 patients ≥65 years old with dizziness/vertigo who visited the otolaryngology clinic were reviewed. Objective data were evaluated by postural balance (posturographic data with eyes open and closed, and one-leg standing test), spontaneous nystagmus, and mean hearing levels. Subjective handicap associated with dizziness/vertigo was assessed using the Dizziness Handicap Inventory (DHI). Subjective mental status of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Information on history (cardiovascular diseases) and fall accidents within the preceding year was collected using an in-house interview sheet. Results: Objective data on postural balance did not correlate with subjective symptoms on DHI or HADS ( P > .05, Pearson’s correlation coefficient). Adjusted logistic regression modeling with the outcome of incident falls revealed that poor postural balance significantly predicted fall risk ( P < .05; 4.9 [1.4-16.8] per 10-cm2 increment). Nystagmus tended to be associated with fall risk. In contrast, DHI score did not predict fall risk ( P = .43; 1.0 [0.9-1.03]). Receiver operating characteristic analysis proposed a cut-off for postural sway with eyes closed >6.1 cm2 as optimal to predict falls in patients with nystagmus (AUC, 0.74; 95% confidence interval, 0.48-0.997). Conclusion: Poor postural balance is associated with increased fall risk after adjusting for subjective symptoms in older adults at otolaryngology clinics. Conversely, the self-perceived dizziness handicap of DHI score is an insufficient tool to evaluate their fall risk.

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