Mechanisms of Increased Fall Risk among Older Adults with Depression: A Causal Mediation Analysis

项目摘要 这个项目的目标是调查和量化主要的之间的直接和间接的关联 抑郁症，临床上显著的抑郁症状，和福尔斯，使用的数据，从一个大的，全国性的- 美国老年人的代表性纵向队列研究。福尔斯经常导致受伤、残疾， 医疗服务费用很高，是65岁及以上成年人与伤害有关的死亡的主要原因。 福尔斯跌倒的风险和从跌倒中的恢复由几个因素决定，包括环境危害、生理危害、 脆弱性、认知、药物、心理健康和社会支持。虽然大量的研究文献 描述了环境和生理在跌倒风险中的作用，但对心理健康的作用知之甚少。 有证据表明，患有重度抑郁症（最常见的精神健康障碍）的人 在老年人中）经历意外跌倒的可能性可能高达四倍， 因为跌倒而受伤的人比没有抑郁的人多。抑郁症的几个相关因素 作为这种关联的潜在中介或调节剂，如抗抑郁药， 药物使用、认知障碍、虚弱和社交网络减少，但 这些机制是未知的。该项目将通过确定和 量化抑郁症和福尔斯之间的关键机制途径，使用一种新的因果中介分析 approach.这项研究将使用具有全国代表性的健康和退休研究的纵向数据 目标1和目标2：确定相对和 重度抑郁症、临床显著抑郁症、 症状和跌倒风险由虚弱、认知障碍和抗抑郁药物介导。目标3： 评估抑郁对功能性能力（工具性活动）的直接和间接影响 日常生活和日常生活活动）通过福尔斯。通过提供相对和绝对风险的证据 与抑郁症相关的福尔斯，这项研究将在两个互补的水平提供关键信息。第一、 描述不同坠落机制的相对影响将为全面的 治疗易受福尔斯和跌倒相关损伤的老年人抑郁症的策略。二是通过 提供了从抑郁到福尔斯和跌倒相关功能障碍的不同途径的定量证据， 该项目将为制定和优先考虑旨在预防跌倒的政策和战略提供信息， 老年人一般。

Project Summary The goal of this project is to investigate and quantify the direct and mediated associations between major depressive disorder, clinically significant depressive symptoms, and falls, using data from a large, nationally- representative longitudinal cohort study of older adults in the US. Falls often lead to injury, disability, substantial health service costs and are the leading cause of injury-related mortality in adults age 65 and older. Risk for and recovery from falls is determined by several factors including environmental hazards, physiological vulnerability, cognition, medications, mental health, and social support. While extensive research literature describes the role of environment and physiology in fall risk, little is known about the role of mental health. Evidence suggests that individuals with major depressive disorder (the most common mental health disorder among older adults) may be up to four times as likely to experience an unintentional fall and more likely to experience injury because of a fall than their non-depressed counterparts. Several correlates of depression have been implicated as potential mediators or moderators of this association, such as antidepressant medication use, cognitive impairment, frailty, and diminished social networks, but the relative importance of these mechanisms is unknown. This project will address this important gap in knowledge by identifying and quantifying key mechanistic pathways between depression and falls, using a novel causal mediation analytic approach. This study will use longitudinal data from the nationally-representative Health and Retirement Study spanning from 2006 to 2010 to address the following specific aims: Aims 1 & 2: Determine the relative and absolute extent to which the associations between major depressive disorder, clinically significant depressive symptoms and fall risk are mediated by frailty, cognitive impairment, and antidepressant medications. Aim 3: To estimate the direct and serially mediated effects of depression on functional abilities (instrumental activities of daily living and activities of daily living) through falls. By providing evidence of the relative and absolute risk of falls associated with depression, this study will provide key information at two complementary levels. First, describing the relative influence of different fall mechanisms will inform the development of comprehensive strategies to treat depression in older adults with vulnerability to falls and fall-related injuries. Second, by providing quantitative evidence of different paths from depression to falls and fall-related functional impairment, this project will inform the development and prioritization of policies and strategies aimed at fall prevention for older adults in general.