Anxiety, Depression, and Fall-Related Psychological Concerns in Community-Dwelling Older People

ArticleinThe American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 21(12) · August 2012with59 Reads
Impact Factor: 4.24 · DOI: 10.1097/JGP.0b013e318266b373 · Source: PubMed
Abstract

Objectives: Establish the association between affect and fall-related psychological concerns (fear of falling, fall-related self-efficacy, balance confidence, and outcome expectancy). Methods: A total of 205 community-dwelling older people (mean age 81, SD 7.5 years) completed the Geriatric Depression Scale-15, Geriatric Anxiety Inventory, Modified Survey of Activities and Fear of Falling, Falls-Efficacy Scale- International, Activity-Specific Balance Confidence Scale, and the Consequences of Falling Scale. Results: Hierarchical regression models showed that anxiety was independently associated with all fall-related psychological concerns; depression was only associated with falls efficacy. Associations between fall-related psychological concerns and age, gender, accommodation,medications, self-rated physical health, falls history, mobility, and sensory aids are also discussed. Conclusion: This is the first study that investigates the association between affect and the four fall-related psychological concerns. Anxiety was a significant factor associated with all four, whereas depression was only associated with activity avoidance. Implications for healthcare providers are discussed.

    • "...ion and anxiety were closely linked to pain (Denkinger et al., 2014) and physical function (Hull et al., 2013), then a greater improvement may have been expected at long term follow-up. Therefore, it is possib..."
      Overall, the findings suggest that TJR is associated with a modest improvement in the levels of depression and anxiety over time, although it is unclear whether this was uniform across all persons. If symptoms of depression and anxiety were closely linked to pain (Denkinger et al., 2014) and physical function (Hull et al., 2013), then a greater improvement may have been expected at long term follow-up. Therefore, it is possible that the symptoms of depression and anxiety increased in some patients, while other patients improved or remained the same.
    [Show abstract] [Hide abstract] ABSTRACT: Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.
    No preview · Article · Aug 2015 · Aging and Mental Health
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    • "...e confidence is, in its own right, disabling and detrimental to the wellbeing of older adults [7] [12]. Among the few measures of balance confidence, one measure, the Activities and Balance Confidence (..."
      ARTICLE IN PRESS PHYST-829; No. of Pages 7 2 B. Stubbs et al. / Physiotherapy xxx (2015) xxx–xxx can consequently increase sensorimotor deconditioning and subsequently increase the older person's risk of falls [8] [9] [10] [11]. Furthermore, reduced balance confidence is, in its own right, disabling and detrimental to the wellbeing of older adults [7] [12]. Among the few measures of balance confidence, one measure, the Activities and Balance Confidence (ABC) scale [13], is favoured among clinicians and has excellent test–retest reliability (r = 0.92, P < 0.001) [13] and internal consistency (Cronbach's alpha = 0.96) [14].
    [Show abstract] [Hide abstract] ABSTRACT: To determine whether musculoskeletal pain (pain severity and number of chronic pain sites; single or multisite) is associated with balance confidence over and above previously established risk factors. Cross-sectional study. Ten community sites (five day centres, two sheltered housing schemes and three community 'clubs') in the UK. Two hundred and eighty-nine community-dwelling older adults [response rate 72%, mean age 78 (standard deviation 8) years, 67% female] completed the study assessment. Eligibility criteria were as follows: living in the community; aged ≥60 years; able to walk ≥10m; able to communicate in English; and no cognitive (e.g. dementia), neurological or mental health conditions. Not applicable. Balance confidence as measured by the 16-item Activities Balance Confidence (ABC) scale (lower scores indicate less confidence). One hundred and fifty participants had at least one site of chronic musculoskeletal pain (52%), and the remaining 139 (48%) participants did not report chronic musculoskeletal pain. Older people with chronic musculoskeletal pain had significantly lower scores on the ABC scale compared with those without chronic musculoskeletal pain (mean 48.3 vs 71.3, P<0.001). After adjustment for established risk factors, two separate hierarchical regression models demonstrated that both pain severity (β=-0.106, P=0.029) and number of chronic musculoskeletal pain sites (β=-0.98, P=0.023) were significantly associated with lower balance confidence. Both pain severity and number of chronic pain sites (particularly multisite pain) are associated with lower balance confidence in community-dwelling older adults. Further research is needed to target pain symptoms and balance confidence in relation to fall risk in older adults with chronic musculoskeletal pain. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · May 2015 · Physiotherapy
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    • "...ve suggested that clinicians should simply refer to the terms falls related psychological concerns [8]. Limitations ..."
      Clinicians should therefore ensure that they are employing the correct outcome measure to capture the phenomenon they wish to measure. In order to avoid confusion, other researchers have suggested that clinicians should simply refer to the terms falls related psychological concerns [8]. Limitations
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. Methods: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. Results: Of a potential 892 articles, 12 met the eligibility criteria (n=3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. Conclusion: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults. Implications for Rehabilitation Pain is a common and pervasive problem in community dwelling older adults and can affect an individual's mobility, levels of physical activity and increase their falls risk. Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review. This review provides provisional evidence that pain may increase older adult's risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy. In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.
    Full-text · Article · Jan 2014 · Disability and Rehabilitation
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