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 抑郁障碍，临床上显著的抑郁症状，以及跌倒，使用了来自一项大型的，全国性的- 对美国老年人的代表性纵向队列研究。跌倒往往会导致受伤、残疾、 医疗服务费用高昂，是65岁及以上成年人因伤致死的主要原因。 跌倒的风险和康复由几个因素决定，包括环境危害、生理风险、 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，对心理健康的作用知之甚少。 有证据表明，患有严重抑郁障碍(最常见的心理健康障碍)的人 在老年人中)可能是意外跌倒的四倍，而且更有可能 因为跌倒而受伤的人比没有抑郁的人更容易受伤。抑郁症的几个相关因素 被牵连为这种关联的潜在调解人或调解人，如抗抑郁药 药物使用、认知障碍、虚弱和社交网络减少，但 这些机制尚不清楚。该项目将通过确定和解决知识方面的这一重要差距 使用一种新的因果中介分析方法量化抑郁症和跌倒之间的关键机制路径 接近。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 从2006年到2010年，以解决以下具体目标：目标1和2：确定相对和 重度抑郁障碍、临床显著抑郁之间的关联绝对程度 虚弱、认知障碍和抗抑郁药物是导致症状和跌倒风险的中介因素。目标3： 评估抑郁对功能能力(工具性活动)的直接和系列中介影响 日常生活和日常生活活动)通过瀑布。通过提供相对和绝对风险的证据 对于与抑郁症相关的跌倒，这项研究将在两个互补的水平上提供关键信息。第一, 描述不同跌倒机制的相对影响将有助于综合 治疗易跌倒和跌倒相关伤害的老年人抑郁的策略。第二，由 提供从抑郁到跌倒和跌倒相关功能障碍的不同路径的定量证据， 该项目将为制定和确定旨在预防跌倒的政策和战略提供信息 一般都是老年人。

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.