Depressive symptoms and fear of falling in previously community-dwelling older persons recovering from proximal femoral fracture Authors
First Online: 31 July 2013 Received: 05 July 2010 Accepted: 07 December 2010 DOI:
Cite this article as: Benzinger, P., Zijlstra, G.A.R., Lindemann, U. et al. Aging Clin Exp Res (2011) 23: 450. doi:10.1007/BF03325241 Abstract Background and aims: Depression and fear of falling are common problems following proximal femoral fracture. The role of fear of falling in depressive symptoms after such a fracture has not yet been investigated. The aim of this study was to establish possible changes during recovery in fear of falling and depressive symptoms following rehabilitation in this population and to explore their association. Methods: Observational study with pre-post design at a single geriatric rehabilitation hospital in Germany. Data were collected during in-hospital rehabilitation and four months later at participants’ home. The data of 51 participants living in the community at the time of fracture could be analysed. Main measures: Fear of falling, depressive symptoms, cognition, pain, ADL functioning, and physical performance. Results: Although physical and ADL performance improved between admission to rehabilitation and follow-up four months later, the prevalence of depressive symptoms increased, and levels of fear of falling remained at the same level. There was a significant correlation between fear of falling and depressive symptoms at follow-up, but the two were not significantly correlated at baseline. Fear of falling and depressive symptoms were not significantly associated in a path analysis model. Conclusions: Fear of falling and depressive symptoms are highly prevalent after proximal femoral fracture. Yet there seems to be no simple association between either psychological parameter in older persons recovering from fall-related fractures. Further research is warranted, in order to develop interventions targeting these psychological outcomes. Key words Depression fear of falling femoral fracture hip fracture rehabilitation Download to read the full article text References
Nightingale S, Holmes J, Mason J et al. Psychiatric illness and mortality after hip fracture. Lancet 2001; 357: 1264–5.
Boonen S, Autier P, Barette M et al. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int 2004; 15: 87–94.
Oude Voshaar RC, Banerjee S, Horan M et al. Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people. Psychol Med 2006; 36: 1635–45.
Burns A, Banerjee S, Morris J et al. Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials. J Am Geriatr Soc 2007; 55: 75–80.
Shyu YI, Liang J, Wu CC et al. Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci 2008; 63: 92–7.
Tinetti ME, Powell L. Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol 1993; 48: 35–8.
Zijlstra GA, van Haastregt JC, van Eijk JT et al. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 2007; 36: 304–9.
Scheffer AC, Schuurmans MJ, van Dijk N et al. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008; 37: 19–24.
Deshpande N, Metter EJ, Bandinelli S et al. Psychological, physical, and sensory correlates of fear of falling and consequent activity restriction in the elderly: the InCHIANTI study. Am J Phys Med Rehabil 2008; 87: 354–62.
PubMedCentral PubMed CrossRef
van Haastregt JC, Zijlstra GA, van Rossum E et al. Feelings of anxiety and symptoms of depression in community-living older persons who avoid activity for fear of falling. Am J Geriatr Psychiatry 2008; 16: 186–93.
Visschedijk J, Achterberg W, Van Balen R et al. Fear of falling after hip fracture: a systematic review of measurement instruments, prevalence, interventions, and related factors. J Am Geriatr Soc 2010; 58: 1739–48.
de LC, Brimacombe M, Pedersen L et al. Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res 2008; 20: 412–8.
Leibson CL, Tosteson AN, Gabriel SE et al. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 2002; 50: 1644–50.
Yesavage JA, Sheikh JI. Geriatric Depression Scale (GDS): Recent evidence and development of a Shorter Version. Clin Gerontol 1986; 5: 165–73.
Hauer K, Yardley L, Beyer N et al. Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: Results of self-report and interview-based questionnaires. Gerontology 2010; 56; 190–9.
Kempen GI, Yardley L, van Haastregt JC et al. The Short FESI: a shortened version of the Falls Efficacy Scale International to assess fear of falling. Age Ageing 2008; 37: 45–50.
Mahony FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J 1965; 14: 61–5.
Stucki G, Meier D, Stucki S et al. [Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index]. Z Rheumatol 1996; 55: 40–9.
Katzman R, Brown T, Fuld P et al. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry 1983; 140: 734–9.
Goring H, Baldwin R, Marriott A et al. Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. Int J Geriatr Psychiatry 2004; 19: 465–71.
Pedhazur EJ. Multiple regression in behavioral research: explanation and prediction, 3rd Ed. Holt, Rinehart, Winston, 1997.
Kempen GI, Todd CJ, van Haastregt JC et al. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disabil Rehabil 2007; 29: 155–62.
Helbostad JL, Taraldsen K, Granbo R et al. Validation of the Falls Efficacy Scale-International in fall-prone older persons. Age Ageing 2010; 39: 259.
Delbaere K, Close JC, Mikolaizak AS et al. The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 2010; 39: 210–6.
Lenze EJ, Munin MC, Skidmore ER et al. Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. J Am Geriatr Soc 2007; 55: 81–6.
Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 2008; 56: 1075–9.
Kempen GI, Sanderman R, Scaf-Klomp W et al. The role of depressive symptoms in recovery from injuries to the extremities in older persons. A prospective study. Int J Geriatr Psychiatry 2003; 18: 14–22.
Cumming RG, Salkeld G, Thomas M et al. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 2000; 55: M299–305.
Herrick C, Steger-May K, Sinacore DR et al. Persistent pain in frail older adults after hip fracture repair. J Am Geriatr Soc 2004; 52: 2062–8.
McKee KJ, Orbell S, Austin CA et al. Fear of falling, falls efficacy, and health outcomes in older people following hip fracture. Disabil Rehabil 2002; 24: 327–33.
Petrella RJ, Payne M, Myers A et al. Physical function and fear of falling after hip fracture rehabilitation in the elderly. Am J Phys Med Rehabil 2000; 79: 154–60.
Chung MC, McKee KJ, Austin C et al. Posttraumatic stress disorder in older people after a fall. Int J Geriatr Psychiatry 2009; 24: 955–64.
Bruggemann L, Nixon RD, Cavenett T. Predicting acute anxiety and depression following hip fracture. J Behav Med 2007; 30: 97–105.
de Jong P, Kempen GI, Sanderman R et al. Depressive symptoms in elderly patients after a somatic illness event: prevalence, persistence, and risk factors. Psychosomatics 2006; 47: 33–42.
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