The association between depressive symptoms and fall accidents among middle-aged and elderly people in China

Construction and validation of a fall risk prediction model in elderly maintenance hemodialysis patients: a multicenter prospective cohort study

PURPOSE

To analyze the risk factors for falls in elderly maintenance hemodialysis patients, construct a nomogram prediction model and validate the application.

BACKGROUND

Elderly maintenance hemodialysis patients face a high risk of falls, and there are fewer and less effective fall-specific assessment tools.

METHOD

A total of 871 elderly hemodialysis patients from 9 hospitals in Chengdu City from October 2023 to December 2024 were selected as the study objects. Baseline characteristics and fall outcomes of patients in the fall group and non-fall group were recorded and compared through 6-month follow-up. Multivariable logistic regression analysis was employed to identify independent risk factors, and construct the nomogram prediction model and complete the internal verification of the model. 218 elderly maintenance hemodialysis patients from three other hospitals in Chengdu City were selected for a 6-month follow-up of falls from January to February 2024 to complete the external validation of the model.

RESULT

The incidence of falls in elderly maintenance hemodialysis patients was 31.96%, and logistic regression analysis showed that age, sex, visual impairment, intradialytic hypotension, cognitive impairment and depression were independent risk factors for falls. Both internal and external validation of the model demonstrated area under the curve greater than 0.80. Furthermore, calibration plots, the Hosmer-Lemeshow test, and clinical decision curves all demonstrated that the model had good calibration and clinical utility.

CONCLUSION

The nomogram constructed based on the above risk factors can provide scientific basis and practical tools for early clinical identification of high-risk groups of falls.

Relationships between muscle strength, lung function, and cognitive function in Chinese middle-aged and older adults: A study based on the China health and retirement longitudinal study (CHARLS)

OBJECTIVE

As the population ages, concerns about cognitive decline have become increasingly relevant in medical consultations. This study aims to analyze the interaction between muscle strength, lung function, and cognitive function in Chinese middle-aged and older adults, providing a theoretical basis for better prevention of cognitive decline.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) wave 3, including 13 716 participants aged 45 years or older. Cognitive function was assessed through two dimensions, resulting in a total score ranging from 0 to 31 points, with higher scores indicating better cognitive function. Muscle strength was measured using normalized grip strength and chair-standing time, while lung function was evaluated using peak expiratory flow (PEF).

RESULTS

Total cognitive function scores exhibited significant correlations with grip strength, chair-standing time, and PEF. Muscle strength and lung function demonstrated significant associations with cognitive function, with lung function emerging as a notable mediating factor. This relationship persisted even after adjusting for potential confounding variables. Specifically, PEF played a substantial mediating role in linking grip strength to cognitive function scores (estimated indirect effect = 0.0132, boot-strapped standard error = 0.0015, boot-strapped standard 95% confidence interval = 0.0104, 0.0162). Additionally, PEF served as a significant mediator in the association between chair-standing time and cognitive function scores (estimated indirect effect = -0.0204, boot-strapped standard error = 0.0023, boot-strapped standard 95% confidence interval = -0.0251, -0.0159).

CONCLUSION

The study highlights the importance of addressing declines in muscle strength and lung function to identify risk factors associated with cognitive function. Understanding these relationships can provide insights into potential pathways linking these variables and may aid in better prevention of cognitive decline. Further long-term longitudinal cohort studies are needed to explore the causality between these factors.

Translation, cross-cultural adaptation, and measurement properties of the Traditional Chinese version of the Fear of Falling Avoidance Behavior Questionnaire in Taiwanese community-dwelling adults

PURPOSE

This study aimed to translate the Fear of Falling Avoidance Behavior Questionnaire (FFABQ) into Traditional Chinese (FFABQ-TC) and to evaluate the psychometric properties of FFABQ-TC in Taiwanese adults.

METHODS

We translated and culturally adapted the FFABQ into Traditional Chinese, ensuring linguistic accuracy and cultural relevance. A total of 230 Taiwanese community-dwelling adults participated in the study. Test-retest reliability was assessed in 30 participants, while 200 participants were included in the validity analysis. Known-groups validity was investigated by comparing the FFABQ-TC scores between fallers and non-fallers. Convergent validity was examined by correlating FFABQ-TC scores with Activities-specific Balance Confidence Scale (ABC), Geriatric Fear of Falling Measure (GFFM), and Timed-Up-and-Go (TUG) test.

RESULTS

The FFABQ-TC demonstrated excellent test-retest reliability (Intraclass Correlation Coefficient = 0.884) and excellent internal consistency (Cronbach's alpha = 0.930). Known-groups analysis revealed that FFABQ-TC significantly differentiated between fallers and non-fallers. Convergent validity was examined and showed significant correlations of FFABQ-TC with the ABC, the GFFM, and TUG.

CONCLUSION

The psychometric properties of FFABQ-TC was established in Taiwanese adults for assessing FOF-related avoidance behaviors. The translated and adapted FFABQ-TC is a reliable and valid clinical tool for evaluating fall risk in this population.

Anxiety, depression, and their association with unintentional injury risk among older adult populations in Guangxi, China: a cross-sectional study

Background

The aging population presents a significant public health challenge, particularly concerning mental health and injury prevention. Anxiety and depression are common among the older adult, affecting their quality of life and increasing the risk of unintentional injuries (UI). This study aims to explore the association between anxiety and depression and UI risk among the older adult in Guangxi, China, using data from the 2023 National Health Service Survey.

Methods

A cross-sectional design was employed, analyzing data from 2,894 participants aged 60 and above in Guangxi. The primary variables were anxiety and depression, assessed via validated scales, with UI as the dependent variable. Logistic regression was used to estimate crude and adjusted odds ratios (OR) with 95% confidence intervals (CI), adjusting for potential confounders such as age, gender, socioeconomic status, and lifestyle factors.

Results

Significant findings indicate that individuals with anxiety and depression had nearly double the risk of UI compared to those without these conditions (adj. OR = 1.92, 95% CI: 1.42-2.6, p < 0.001). Alcohol consumption was also associated with higher UI risk (adj. OR = 1.46, 95% CI: 1.05-2.03, p = 0.023). Females had a significantly higher adjusted odds of UI compared to males (adj. OR = 1.38, 95% CI: 1.03-1.84, p = 0.029), and rural residents were more likely to experience UI than urban dwellers (adj. OR = 1.38, 95% CI: 1.05-1.82, p = 0.02). Exercise frequency was inversely related to UI risk, with those exercising 1-2 times per week having reduced odds (adj. OR = 0.46, 95% CI: 0.22-0.98, p = 0.044). Other factors such as age, marital status, hypertension, diabetes, and main caregiver showed no significant associations with UI.

Conclusion

Addressing mental health issues and promoting moderate exercise may help reduce UI risk in the older adult. Policies should focus on enhancing mental health services and injury prevention programs, particularly in rural settings, to improve the overall health and safety of the aging population in Guangxi.

Sleep and risk of hip fracture and falls among middle-aged and older Chinese

The study aimed to assess the prospective associations between sleep duration, sleep restfulness, midday napping and hip fracture (HF) and falls in a nationally representative Chinese population. Data were from the China Health and Retirement Longitudinal Study which was conducted from 2013 to 2018. In total, 10,508 individuals without a history of HF in 2013 were included. Nighttime sleep duration, sleep restfulness and midday napping were self-reported. Logistic regression analyses were performed to examine the relationships between sleep problems and HF as well as falls, adjusting for covariates. A total of 313 (3.0%) participants reported HF, and 3899 (37.1%) experienced at least one fall event over the following 5-year period. Participants who had a short sleep duration (≤ 6) were more likely to report HF (OR = 1.27, 95% CI = 1.00-1.62) and falls (OR = 1.18, 95% CI = 1.07-1.30) than those who had a normal sleep duration (6-9 h) in the fully adjusted model. Participants having unrestful sleep were also more likely to report falls (OR = 1.23, 95% CI = 1.11-1.36) than those who had restful sleep. However, there was no significant association between midday napping and HF and falls. In conclusion, short sleep duration and sleep restfulness were independently associated with an increased risk of HF and falls, which may have important clinical and public health implications. Interventions to improve sleep quality may reduce the risk of HF and fall accidents among middle-aged and older people.

The impact of social activities on mental health among older adults in China

Background

Understand the current situation of social activities among older adults and its impact on mental health, providing policy basis and intervention measures to improve the mental health of the older adult.

Method

Collect relevant data from 8,181 older adults aged ≥ 60 years old from the 2020 China Health and Retirement Longitudinal Study (CHARLS), constructing an analysis framework for social activities of older adults in China from three aspects: participation in social activities, number of social activities, frequency of social activities, and describe them, then analyzing the impact of social activities on their mental health using OLS and 2SLS regression models. This study also discusses the impact of eight social activities on the mental health of older adult people through subgroup.

Result

Among 8,181 older adults aged 60 and above, 3,808 participated in social activities (56.24%), average number of social activities is 0.71, and average frequency of social activities is 1.31 times. The average score of mental health level measured by CES-D is 15.24 points. Participate in social activities can reduce the depression level of the older adult (β = -0.352, 95%CI: -0.547~-0.158); the more social activities the older adult participate in, the lower the depression level of the older adult (β = -0.214, 95%CI: -0.313~-0.115); the higher the frequency of participating in social activities, the lower the depression level of the older adult (β = -0.133, 95%CI: -0.182~-0.083). In summary, social activities can improve the mental health level of the older adults in China. As for different types of social activities, visiting and socializing with friends, participating in club organization activities, playing mahjong, chess, cards, or going to community activity rooms and attending school or training courses can improve the mental health of the older adult.

Discussion

The social activities in three dimensions among older adults in China need to be further improved, and participating in social activities can help improve their mental health. The conclusion provides important policy implications for encouraging and supporting older adults to participate in various social activities, increasing the number and frequency of older adult social activities, then help improving the mental health level of older adults.

Prevalence and factors associated with falls in older adults in a Middle Eastern population: a retrospective cross-sectional study

OBJECTIVE

The main objective was to determine the prevalence of falls and associated factors in older adults living in Qatar.

STUDY DESIGN

Cross-sectional study.

METHODS

This is a cross-sectional study of older adults aged ≥60 years with at least one encounter with primary health care corporation (PHCC) in Qatar during the period 2017-2022. Data on documented falls, demographic variables, and medical comorbidities were extracted from all PHCCs in Qatar. Descriptive and inferential statistics were used to address the aim of the study.

RESULTS

A total of 68,194 older adults had at least one encounter with PHCC. The median age was 65.0 years, 58.9% were males, and 32.6% were Qatari nationality. A higher percentage of falls was found in individuals with hypertension (80%), diabetes (74.2%), and dyslipidemia (48.9%), which were also the most prevalent comorbidities. The prevalence of falls was 6.7% (95% CI 6.6-6.9). Compared to individuals aged 60-69 years, individuals aged 70-79, 80-89, and 90-99 had increased odds of falls by 1.6 (95% CI 1.5, 1.8), 2.5 (95% CI 2.2, 2.8), and 2.6 (95% CI 2.0, 3.3), respectively. Females and individuals of Qatari nationality had increased odds of fall by 1.5 (95% CI 1.4, 1.6) and 1.2 (95% CI 1.1, 1.3), respectively. Orthostatic hypotension, syncope, Parkinson's disease, and hip arthritis showed the strongest associations with falls.

CONCLUSIONS

Given the growing population of older adults in the Middle East and North African region, falls is a public health concern. The risk factors identified in this study suggest the need for proactive healthcare strategies tailored to the unique needs of older adult populations.

Effect of chronic pain on the occurrence of falls in older adults with disabilities: a prospective cohort study

BACKGROUND

The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not.

OBJECTIVE

This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities.

METHODS

The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates.

RESULTS

After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057-9.495, p = .04).

CONCLUSION

Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities.

Risk of fall in patients with chronic kidney disease: results from the China health and retirement longitudinal study (CHARLS)

BACKGROUND

Chronic kidney disease (CKD), often coexisting with various systemic disorders, may increase the risk of falls. Our study aimed to assess the prevalence and risk of falls among patients with CKD in China.

METHODS

We included patients with/without CKD from China Health and Retirement Longitudinal Study (CHARLS). Our primary outcome was the occurrence of fall accidents within the past 2 years. To enhance the robustness of our findings, we employed a multivariable logistic regression model, conducted propensity score analysis, and applied an inverse probability-weighting model.

RESULTS

A total of 12,658 participants were included, the prevalence of fall accident rates were 17.1% (2,028/11,837) among participants without CKD and 24.7% (203/821) among those with CKD. In the inverse probability-weighting model, participants with CKD exhibited higher fall accident rates (OR = 1.28, 95% CI: 1.08-1.53, p = 0.005 ). Sensitivity and subgroup analysis showed the results still stable.

CONCLUSIONS

The population in China afflicted with CKD has a significantly heightened risk of experiencing falls, underscoring the crucial importance of intensifying efforts in assessing and preventing fall risks.

Demographics moderated the association of symptom burden with falls and fall-related outcomes

OBJECTIVES

To examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults.

METHODS

We used 2011-2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors.

RESULTS

The majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.20, 95% CI: 1.18-1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20-1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes.

CONCLUSIONS

Symptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.

Prevalence and risk factors for falls among community-dwelling adults in Riyadh area

Objectives

This study aimed to assess fall prevalence, identify related risk factors, and establish cut-off scores for fall risk measures among community-dwelling adults in Riyadh region of Saudi Arabia.

Methods

A cross-sectional study was conducted in community, Riyadh city, Saudi Arabia. A sample of 276 Saudi citizens aged ≥40 years who were able to read and write in Arabic. Fall history and number of falls in the past 12 months were determined via self-reports. Variables assessed included demographic information, self-reported chronic diseases, depressive symptoms, and back pain severity.

Results

Participants were classified as either fallers (n = 28, 10.14%) or non-fallers. Fallers were more likely to have arthritis (odds ratio [OR]: 7.60, p = 0.001), back pain (OR: 5.22, p = 0.002), and higher depressive symptom scores (OR: 1.09, p = 0.013) than non-fallers. The number of reported falls was significantly associated with an elevated body mass index (incidence rate ratio [IRR]: 1.09, p = 0.045), arthritis (IRR: 8.74, p < 0.001), back pain (IRR: 4.08, p = 0.005), neurological diseases (IRR: 13.75, p < 0.007), and depressive symptoms (IRR: 1.08, p = 0.005). Cut-off scores predictive of falls associated with back pain and depressive symptoms were 1.5 (sensitivity: 0.61; specificity: 0.79; area under the curve [AUC]: 0.70) and 11.5 score (sensitivity: 0.57; specificity: 0.76; AUC: 0.66), respectively.

Conclusions

The prevalence of falls was relatively low among the individuals considered in this study. Chronic conditions, back pain severity, and depressive symptoms were determined to be associated with falls among community-dwelling individuals in Saudi Arabia.

Low physical activity and depression are the prominent predictive factors for falling in older adults: the Birjand Longitudinal Aging Study (BLAS)

BACKGROUND

Falling in the older adults has many irreparable consequences, including hospitalization to long-term care centers and loss of independence, depression and social isolation, financial burden, and death. The present study was conducted to estimate the incidence of falls and their associated factors among community-dwelling older adults.

METHODS

This program is a population-based prospective cohort study (≥ 60 years) in Birjand City from 2019 to 2020. A total of 1418 participants were included in the study, and 1344 participants were analyzed according to the inclusion criteria. Thirty-nine risk factors were evaluated. Basic information included demographic information, lifestyle factors, general health and medical history, and mental and functional health.

RESULT

The incidence of falls among community-dwelling older adults in the previous approximately 24 months in the present study was 9.26% in women and 2.65% in men. In the multiple Cox proportional regression model based on fall risk factors, there was a strong significant relationship between male sex (HR = 0.37, CI = 0.21 to 0.64), being physically active (HR = 0.59, CI = 0.36 to 0.96), moderate-to-severe depression (HR = 2.97, CI = 1.47 to 6.01), severe depression (HR = 3.26, CI = 1.24 to 8.54), and high risk of falls according to the TUG test (HR = 1.73, CI = 1.10 to 2.72).

CONCLUSIONS

Inactivity and depression were recognized as important factors in falls in older adults. It is recommended for older adults to have an active lifestyle to prevent falls and to prioritize the diagnosis and treatment of depression in older adults. Women as a group at higher risk should be considered in prevention programs. In addition, the use of the TUG test to identify high-risk older adults should be considered.

Association between changes in depressive symptoms and falls: The China health and retirement longitudinal study (CHARLS)

PURPOSE

This study aimed to investigate the impact of depressive symptoms and changes in depressive status on falls among middle-aged and older population in China.

METHODS

We used two waves of interview data (time 1 [T1] and time 2 [T2], 2 years from T1) from a nationally representative sample of the China Health and Retirement Longitudinal Study (CHARLS), which included a total of 14,356 participants (male 6859; mean age: 59.5 ± 9.3 years). Depressive symptoms were assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D-10). Participants were categorized into four groups based on changes in their CES-D-10 scores over a 2-year follow-up period. Self-reported falls were evaluated, and logistic regression models and restricted cubic splines (RCS) were employed to examine the relationship between depressive symptoms and fallen.

RESULTS

Participants who had experienced falls had higher CES-D-10 scores and were more likely to have depressive symptoms. Depressive symptoms at T1 were significantly associated with falls during the follow-up period. After adjusting for covariables, increasing CES-D-10 scores were associated with higher adjusted odds ratios (ORs) for falling prevalence: 1.230 (95 % CI, 1.041-1.453), 1.579 (95 % CI, 1.331-1.873), 1.745 (95 % CI, 1.472-2.070), and 2.366 (95 % CI, 1.972-2.838). Participants who experienced depressive symptoms at either T1 or T2, as well as those with persistent depressive symptoms from T1 to T2, were both at higher risk for future falls. The worsening of depressive symptoms significantly increased the likelihood of falls.

CONCLUSION

This study revealed a significant association between depressive symptoms and changes in depressive status with subsequent falls in older adults. The heightened fall risk among individuals with depressive symptoms underscores the importance of addressing mental health as an integral part of comprehensive fall prevention strategies.

The association between falls and depressive symptoms among older adults: evidence from the China Health and Retirement Longitudinal Study

Background

Falls place a heavy burden on older adults and families, and there was little research on the relationship between falls and depressive symptoms among older adults in China. This study is designed to examine the association between falls and depressive symptoms in Chinese older adults.

Methods

This study was based on 9,539 data sets from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. The 10-item Center for Epidemiologic Studies-Depression Scale (CESD-10) was used to access depressive symptoms in older adults. A logistic regression model was used to calculate multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for falls and depressive symptoms, adjusted for possible confounders. The Classification and regression tree (CART) demonstrates the prediction of the target variable values based on other variables.

Results

In this study, 9,539 older people were selected: 60-69 years old accounted for 63.0%, 70-79 years old accounted for 29.7%, and 80 years old and above accounted for 7.3%. Male accounted for 49.7% and female for 50.3%. The rate of falls among older adults was 21.4%, and the rate of depressive symptoms was 33.9%. Adjusted ORs (OR = 1.37, 95% CI: 1.23, 1.53) showed a significant association between falls and depressive symptoms among older adults. Subgroup analysis revealed that this association was statistically significant across male (OR = 1.29, 95% CI: 1.23, 1.53) and female (OR = 1.42, 95% CI: 1.23, 1.64), 60-69 aged (OR = 1.38, 95% CI: 1.19, 1.60) and 70-79 aged (OR =1.42, 95% CI: 1.16, 1.74), rural (OR = 1.42, 95% CI: 1.25, 1.61), <15,000 CNY (OR = 1.35, 95% CI: 1.19, 1.54) and more than 25,000 CNY (OR = 1.42, 95% CI: 1.09, 1.85). Additionally, The CART model showed that the probability (73.0%) of falls was highest among older adults with depressive symptoms who self-rated poor health and female gender.

Conclusions

This cross-sectional study demonstrated a significant association between falls and depressive symptoms in Chinese older adults. The findings provide some evidence and support for risk monitoring, screening for depressive symptoms, and early prevention in the high-risk older population.

Regional and temporal trends of falls and injurious falls among Chinese older adults: results from China Health and Retirement Longitudinal Study, 2011-2018

OBJECTIVE

This study aimed to investigate temporal trends and regional differences of both falls and injurious falls among Chinese older adults and identify the associated risk factors.

METHODS

We conducted a retrospective analysis using the 2011, 2013, 2015 and 2018 waves of China Health and Retirement Longitudinal Study. Our sample included 35 613 people aged 60 years or above. We analysed two binary outcome variables that were collected at each wave, including whether a respondent had any falls in the last 2 or 3 years, and if so, whether a respondent experienced any injurious falls that warranted seeking medical treatment. The explanatory variables included individual-level sociodemographic characteristics, physical function and health status. We conducted both descriptive and multivariate logistic analyses.

RESULTS

We found no significant trend for falls after adjusting for individual-level factors, while significant regional variations in falls existed with higher fall prevalence in the central and western areas, compared with the eastern area. We detected a significant descending trend of injurious falls between 2011 and 2018 and identified the northeastern region with the lowest rates of injurious falls during the study period. Our study also revealed significant risk factors for falls and injurious falls, such as chronic conditions and function limitations.

CONCLUSIONS

Our results indicated no temporal trend of falls, a declined trend of injurious falls, and significant regional variations in the prevalence of falls and injurious falls in 2011-2018. These findings have important implications for prioritising areas and subpopulations to prevent falls and injuries among China's elderly population.

Prevalence of falls, injury from falls and associations with chronic diseases among community-dwelling older adults in Guangzhou, China: a cross-sectional study

Introduction

As a developing country with the largest older adult population in the world, strengthening the research on falls among the older adults is undoubtedly an urgent item in China. This study aimed to explore the prevalence and risk factors associated with falls and injury from falls among community-dwelling older adults in Guangzhou, China, particularly focusing on their associations with chronic diseases.

Methods

A total of 1,629 participants aged 65 years and above were selected from 11 counties in Guangzhou by the multi-stage stratified random sampling method in 2021. Socio-demographic characteristics, health and lifestyle factors, the status of falls, and injury from falls were measured by structured questionnaires through face-to-face interviews. Chi-square tests and logistic regression analysis were used to identify factors associated with falls and injury from falls. Chord diagrams were used to explore their associations with chronic diseases.

Results

A total of 251 participants (15.41%, 95% CI: 13.98%-17.25%) reported falls, and 162 participants (9.46%, 95% CI:7.72%-11.55%) indicated an injury from falls. Logistic regression analysis showed the results as follows: female patients (adjusted OR = 1.721, 95% CI: 1.681-1.761) aged ≥80 years (1.910, 1.847-1.975), unemployed (1.226, 1.171-1.284), uninsured (1.555, 1.448-1.671), average monthly household income of 2,001-4,000 CNY (1.878, 1.827-1.930), number of services provided by the community health center ≥13 times per year (1.428, 1.383-1.475), illness within 2 weeks (1.633, 1.595-1.672), high-intensity physical activity (2.254, 2.191-2.32), sedentary (1.094, 1.070-1.117), and number of chronic disease illnesses ≥3 (1.930, 1.870-1.993). Meanwhile, those risk factors were also associated with injury from falls. The older adults with medium-intensity physical activity were at lower risk (0.721, 0.705-0.737) of falls and higher risk (1.086, 1.057-1.117) of being injured from falls. Chord diagrams showed the correlations between chronic diseases and falls and injury from falls among community-dwelling older adults in Guangzhou, China.

Conclusion

The high prevalence of falls is found among community-dwelling older adults in Guangzhou, China, which is related to multiple factors such as demographic variables, lifestyle, and health status, especially for chronic diseases. Therefore, targeted interventions should be developed and implemented urgently.

Association between mild cognitive impairment and falls among Chinese older adults: the mediating roles of balance capacity and depressive symptoms

BACKGROUND

This study aimed to examine the association between mild cognitive impairment (MCI) and the follow-up risk of falls among Chinese older adults, exploring the mediating roles of balance capacity and depressive symptoms in the association between MCI and falls.

METHODS

A total of 5482 adults aged 60 years and above from waves 2015 and 2018 of the China Health and Retirement Longitudinal Study were included for analysis. Cognition was assessed by a global cognition score, which included three tests: episodic memory, figure drawing and Telephone Interview of Cognitive Status. Depressive symptoms were assessed with the Centre for Epidemiological Studies Depression Scale. Logistic regression models were used to estimate the association between MCI and falls. Mediation analysis was employed to explore the potential mediating roles of balance capacity and depressive symptoms in the association between MCI and falls.

RESULTS

MCI was significantly associated with the risk of falls (OR 1.259, 95% CI 1.080 to 1.467). Balance capacity and depressive symptoms played parallel mediating roles in the association between MCI and falls, and the mediating effects were 0.004 (95% CI 0.003 to 0.024) and 0.010 (95% CI 0.004 to 0.016), respectively.

CONCLUSIONS

It is necessary to screen for and recognise MCI in order to prevent falls among older adults. More efforts should be made to improve balance capacity and relieve depressive symptoms to reduce the risk of falls among older adults with MCI.

Tridirectional association between probable depression, fear of falling and falls among middle-aged and older adults in Thailand

PURPOSE

Depression is a major issue in the aging population, which may be related to fear of falling (FOF) and falls contributing to increased morbidity and mortality. The aim of the study was to assess the tridirectional associations between probable depression (PD), FOF and falls in a longitudinal study in Thailand.

METHODS

Longitudinal data of participants (≥45 years; N = 3708) from two consecutive waves (in 2015 and 2017) of the Health, Aging and Retirement in Thailand (HART) study were analysed. PD was assessed with the Center for Epidemiologic Studies Depression Scale, self-reported FOF and history of falls.

RESULTS

Having no PD in 2015 and PD in 2017 (aOR: 2.35, 95% CI: 1.67 to 3.30), and having both PD in 2015 and 2017 (aOR: 3.46, 95% CI: 1.92 to 6.23) were positively associated with incident FOF with activity avoidance, and no FOF in 2015 and FOF in 2017 (aOR: 2.29, 95% CI: 1.77 to 2.95), and both FOF in 2015 and 2017 (aOR: 2.38, 95% CI: 1.69 to 3.36) were positively associated with incident PD. Two or more falls in 2015 (aOR: 2.03, 95% CI: 1.29 to 3.19) was positively associated with incident PD, and both PD in 2015 and 2017 (aOR: 3.10, 95% CI: 1.40 to 6.48) were positively associated with incident multiple (≥2) falls.

CONCLUSIONS

We found tridirectional associations between PD, FOF and falls. It is suggested to screen and manage older adults for PD, FOF and fall history simultaneously.

Longitudinal association between falls and motoric cognitive risk syndrome among community-dwelling older adults

The motoric cognitive risk (MCR) syndrome is a predementia syndrome associated with dementia and mortality risk. This longitudinal study aimed to investigated the longitudinal association between MCR and falls in older adults, including 3,720 participants in the China Health and Retirement Longitudinal Study. A total of 482 participants (13.0%) met the MCR requirements at baseline. There were 226 incident cases of MCR (13.0%) throughout follow-up (duration: 4 years). Controlling for microsystem factors, a single fall (OR: 2.412, 95 % CI: 1.100-5.290; p < .05) was associated with incident MCR at baseline and to almost 2.0 times (HR: 2.021, 95 % CI: 1.031-3.961; p < .05) more inclined to develop MCR over time, compared to those without falls. These associations remained significant when meso/ exosystem factors and macrosystem factors were included in the analytic models. Falls may be useful in predicting MCR risk in the near future among Chinese older adults.

Association Between Multiple Chronic Conditions and Depressive Symptoms Among Older Adults in China: Evidence From the China Health and Retirement Longitudinal Study (CHARLS)

Objectives: The purpose of this study was to explore the association between multiple chronic conditions (MCCs) and depressive symptoms among older adults in China. Methods: We used the fourth round of data from the China Health and Retirement Longitudinal Study, and included 9789 older adults aged 60 years old and above. Results: Compared with the older adults without chronic disease, older adults with MCCs and those with one chronic disease had a high risk of depression (MCCs: OR_-adjusted: 1.55, 95% CI: 1.37 to 1.75; one chronic disease: OR_-adjusted: 1.20, 95% CI: 1.05-1.37). In urban areas, the prevalence among older adults with MCCs was 2.01 times higher than that among older adults without chronic disease (OR_-adjusted: 2.01, 95% CI: 1.56-2.60), while it was 1.44 times higher in rural areas (OR_-adjusted:1.44, 95% CI: 1.25-1.65). Self-reported health, duration of sleep, social activities, and type of medical insurance were the influencing factors of depressive symptoms in older adults. Conclusion: This study contributed to enriching the research on the relationship between MCCs and depressive symptoms in older adults in China.

The Incidence of Falls and Related Factors among Chinese Elderly Community Residents in Six Provinces

This cross-sectional study classified the factors related to falls among residents ≥ 60 years old in China in order to provide evidence for the prevention of falls in the elderly. A total of 2994 participants were enrolled, and the correlations between social demography, physical health, self-health management awareness, family support, and fall risk were analyzed. Factors influencing falls were classified by location, cause, and the activity during falls. Suffering from osteoarthropathy (OR = 1.761, 95% CI: 1.234-2.513, p < 0.05), depression or anxiety (OR = 1.896, 95% CI: 1.331-2.700, p < 0.001), household size > 2 (OR = 1.806, 95% CI: 1.042-3.130, p < 0.05), and poor self-assessed health (OR = 1.478, 95% CI: 1.107-1.972, p < 0.01) were risk factors. Higher participation in community health programs (OR = 0.522, 95% CI: 0.298-0.912, p < 0.05) and spousal support (OR = 0.909, 95% CI: 0.841-0.981, p < 0.05) were protective factors. Falls were divided into the following categories: stairs/hallway (vision, attention problems), bath/toilet (vision, attention problems, slipping), indoor housework (dizziness, leg weakness), and outdoor activities (attention, surface problems). While acknowledging that the personal physical and mental health of the elderly may lead to falls, community support, accelerated transformation of housing, and the construction of barrier-free environments play an important role in reducing the risk of falls.

Depressive symptoms increase the risk of falls and injurious falls in Chinese adults aged ≥ 45 years: A 3-year cohort study

Background

Falls and depressive symptoms are both public health concerns in China, but the effects of depressive symptoms on falls and injurious falls have not been thoroughly investigated.

Methods

This population-based prospective cohort study used data derived from adults aged ≥45 years acquired from the 2015 and 2018 China Health and Retirement Longitudinal Study. Data were analyzed from August 2021 to December 2021. Self-reported depressive symptoms were determined using a 10-item Center for Epidemiologic Studies Depression scale (CESD-10) with a total score range of 0-30. Item responses of 3-4 or 5-7 days were deemed indicative of specific depressive symptoms. The outcome variables were self-reported accidental falls and injurious falls.

Results

Of the 12,392 participants included in the study, 3,671 (29.6%) had high baseline depressive symptoms (CESD-10 scores ≥ 10), 1,892 (15.3%) experienced falls, and 805 (6.5%) experienced injurious falls during 2015-2018 follow-up. High depressive symptoms increased the risk of falls [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.19-1.50] and injurious falls (OR 1.28, 95% CI 1.09-1.51) in a multivariable logistic regression model adjusted for major demographic, health-related, and anthropometric covariates. All of the 10 specific depressive symptoms except "felt hopeless" were associated with falls, and four specific symptoms significantly increased the risk of injurious falls; "had trouble concentrating" (OR 1.32, 95% CI 1.13-1.55); "felt depressed" (OR 1.32, 95% CI 1.12-1.55); "everything was an effort" (OR 1.23, 95% CI 1.04-1.45); and "restless sleep" (OR 1.18, 95% CI 1.02-1.40).

Conclusion

High depressive symptoms are significantly related to risk of falls and injurious falls. Four specific symptoms (had trouble concentrating, felt depressed, everything was an effort, and restless sleep) increase the risk of injurious falls in Chinese adults aged ≥ 45 years.

The Outcome of Total Knee Arthroplasty for Patients with Psychiatric Disorders: A Single-Center Retrospective Study

Background and Objectives: For some years, psychiatric illness has been a major factor in evaluating the results of total knee arthroplasty. As with other patient-related items, patients diagnosed with mental illness have higher costs of medical treatment, longer recovery, and longer hospital stays. The aim of this paper is to evaluate the role of mental diseases on the surgical outcome compared with the normal population. Materials and Methods: At our hospital, we undertook a retrospective study between June 2020 and January 2022. The experimental group consisted of patients with mental diseases including schizophrenia, bipolar disease, depression, substance uses, or other psychiatric disorders. The control group consisted of patients who underwent total knee arthroplasty and did not have a mental disease. Postoperative complications and length of stay were also recorded during the study. We used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) as outcome measures. Results: Between June 2020 and January 2022, a total of 634 patients underwent total knee arthroplasty in our clinic, of which 239 had a mental disease. The majority of patients were female (61%), and the average length of stay was significantly longer for patients with mental illness (6.8 vs. 2.8 days). Preoperative WOMAC and KS function scores demonstrated statistically significant differences between groups (67.83 ± 17.8 vs. 62.75 ± 15.7 and 29.31 ± 19.8 vs. 34.98 ± 21.3). KS knee score did not show any significant differences preoperatively. All postoperative functional scores showed significantly better results for the control group compared to the mental illness group. Conclusions: Mental illness appears to be linked with lower TKA scores before and after the surgical procedure.

Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis

BACKGROUND

With increasing life expectancy, declining mortality, and birth rates, the world's geriatric population is increasing. Falls in the older people are one of the most common and serious problems. Injuries from falls can be fatal or non-fatal and physical or psychological, leading to a reduction in the ability to perform activities of daily living. The aim of this study was to determine the prevalence of falls in the older people through systematic review and meta-analysis.

METHODS

In this systematic review and meta-analysis, the data from studies on the prevalence of falls in the older people in the world were extracted in the databases of Scopus, Web of Science (WoS), PubMed and Science Direct, and Google Scholar, Magiran and Scientific Information Database (SID) without any time limit until August 2020. To analyze the eligible studies, the stochastic effects model was used, and the heterogeneity of the studies with the I² index was investigated. Data analysis was conducted with Comprehensive Meta-Analysis software (Version 2).

RESULTS

In the review of 104 studies with a total sample size of 36,740,590, the prevalence of falls in the older people of the world was 26.5% (95% CI 23.4-29.8%). The highest rate of prevalence of falls in the older people was related to Oceania with 34.4% (95% CI 29.2-40%) and America with 27.9% (95% CI 22.4-34.2%). The results of meta-regression indicated a decreasing trend in the prevalence of falls in the older people of the world by increasing the sample size and increasing the research year (P < 0.05).

CONCLUSION

The problem of falls, as a common problem with harmful consequences, needs to be seriously considered by policymakers and health care providers to make appropriate plans for preventive interventions to reduce the rate of falls in the older people.

The Correlation Between Falls and Cognitive Frailty in Elderly Individuals With Hypertension in a Chinese Community

Background

Cognitive frailty refers to the presence of both physical frailty and mild cognitive impairment without simultaneous diagnosis of Alzheimer's disease or other dementia. Epidemiological studies have confirmed the correlation between falls and cognitive frailty, but no study has investigated the relationship between fall risk and cognitive frailty in hypertensive elderly Chinese individuals.

Methods

From December 2020 to March 2021, during face-to-face interviews, community-dwelling elderly individuals with hypertension aged 60~89 in Pudong New Area, Shanghai, were evaluated for cognitive frailty, fall history, and depression, and sociodemographic characteristics were collected. Logistic regression was used to analyze the correlation between falls and cognitive frailty.

Results

A total of 305 elderly people were investigated in this study, and 173 (56.7%, 95% CI =51.2%~62.2%) reported falling once or more in the previous year. Cognitive frailty is closely related to falls and was an independent risk factor for falls (OR = 2.661, 95% CI = 1.063~6.659). Other risk factors included old age (OR = 4.306, 95% CI = 1.852~10.013), female sex (OR = 1.988, 95% CI = 1.185~3.335) and depression (OR = 2.936, 95% CI = 1.069~8.060).

Conclusion

Cognitive frailty is an important risk factor for falls in elderly individuals with hypertension in Chinese communities.

Prospective association between depressive symptoms and hip fracture and fall among middle-aged and older Chinese individuals

BACKGROUND

The effect of depressive symptoms on hip fracture (HF) and falls among the Chinese population is unclear. This study aims to examine the prospective association between depressive symptoms and HF as well as fall accidents in a nationally representative Chinese population.

METHODS

We used data from 10,596 participants in the Chinese Health and Retirement Longitudinal Study (from 2011 to 2018) who were aged ≥45 years and had no HFs at baseline. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiological Studied Depression scale (cutoff for distinguishing high versus low at ≥12). Logistic regression analyses adjusted for demographic characteristics, lifestyle factors and physical comorbidities were performed.

RESULTS

For the analysis of baseline depressive symptoms and HF, 399 (3.8%) participants reported HF accidents in the following 7-year period. Individuals with elevated depressive symptoms at baseline experienced a markedly higher HF risk (odds ratio [OR] = 1.33, 95% confidence interval [CI] = 1.06-1.67) than those without elevated depressive symptoms, after adjusting for a wide range of potential confounders. For the analysis of baseline depressive symptoms and falls, 3974 (37.5%) experienced fall accidents during the follow-up. The presence of elevated depressive symptoms was independently associated with an increased risk of fall events (OR = 1.21, 95% CI = 1.10-1.33). These associations were consistent across multiple characteristics.

CONCLUSIONS

In conclusion, elevated depressive symptoms were associated with an increased risk of HF and falls, which may have considerable clinical and preventive implications.

Factors affecting the evolution of Chinese elderly depression: a cross-sectional study

Background

In the past decades, China’s rapid economic growth has been accompanied by rapid changes in lifestyle and an increasing prevalence of mental disorders. This study explored the changes and factors associated with depression among the elderly population of China from 2011 to 2018.

Method

Data were obtained from the China Health and Retirement Longitudinal Study. The total sample size consists of 21,484 individuals aged ≥60 years, and the sample sizes in 2011, 2013, 2015 and 2018 were 5081, 4853, 5207, 6343, respectively. Depressive symptoms were measured by the 10-item Short-Form developed by the Center for Epidemiological Studies Depression.

Result

We found that the tendency in depression rate of the Chinese elderly from 2011 (36.8%) to 2018 (44.5%). The results showed poor health (OR = 3.553), ADL damage (OR = 2.010), multiple chronic diseases (OR = 1.287), and western (OR = 1.777) are risk factors for depression.

Conclusion

The rate of depression of the elderly people in China has risen dramatically. Therefore, additional steps to prevent, treat and care for the affected population are needed, Mental health prevention and treatment strategies should be incorporated into China’s public health policies in a timely manner to mitigate the serious economic burden caused by the increase of depression.

Association Between Sensory Loss and Falls Among Middle-Aged and Older Chinese Population: Cross-Sectional and Longitudinal Analyses

Introduction: Previous studies have suggested that sensory loss is linked to falls. However, most of these studies were cross-sectional designed, focused on single sensory loss, and were conducted in developed countries with mixed results. The current study aims to investigate the longitudinal relationship between hearing loss (HL), vision loss (VL) and dual sensory loss (DSL) with falls among middle-aged and older Chinese population over 7 years. Methods: The data was obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 7,623 Chinese older adults aged over 45 were included at baseline 2011 in this study. Self-reported falls and HL/VL/DSL were accepted. Other confounding variables included age, sex, BMI, educational level, marital status, various physical disorders and lifestyles. The impact of baseline sensory status on baseline prevalence of falls and incident falls over 7 years were assessed using logistic regression analyses. A logistic mixed model was used to assess the association between time-varying sensory loss with incident falls over 7 years after adjusted with multi-confounding factors. Results: Single and dual sensory loss groups had significantly higher prevalence of falls compared to no sensory loss (NSL) group (DSL: 22.4%, HL: 17.4%, VL: 15.7%, NSL: 12.3%). Baseline HL (OR: 1.503, 95% CI: 1.240-1.820), VL (OR: 1.330, 95% CI: 1.075-1.646) and DSL (OR: 2.061, 95% CI: 1.768-2.404) were significantly associated with prevalence of falls. For longitudinal observation over 7 years, baseline HL/DSL and persistence of all types of sensory loss were associated with incidence of falls. Time-varying HL (OR: 1.203, 95% CI: 1.070-1.354) and DSL (OR: 1.479, 95% CI: 1.343-1.629) were associated with incident falls after adjusted with multi-confounders, while VL was not. Conclusion: HL and DSL are significantly associated with both onset and increased incidence of falls over 7 year's observation in middle-aged and elderly Chinese population. Persistence or amelioration of sensory loss status could exert divergent influences on incidence of falls, which should be considered in the development of falls-prevention public health policies for aging population.

Prevalence and Risk Factors for Fall among Rural Elderly: A County-Based Cross-Sectional Survey

AIM

The aim of the study was to provide evidence for the prevention and reduction of falls in the elderly living in rural areas by analyzing epidemiological data of falls among the rural older people (>65 years old) and identifying the risk and protective factors.

METHODS

This study analyzed the sociodemographic characteristics, living environment, lifestyle, chronic disease condition, mental health, activities of daily living (ADL), and detailed information of falls of 3752 rural elderly. Rank tests, chi-square tests, and binary logistic regression were used for data analysis.

RESULTS

The prevalence of falls was 30.0%, and the 75-84-years age group had the highest fall rate (18.8%). According to the binary logistic regression analysis, six variables, including roughage intake frequency, age, gender, cane use, floor tiles, and IADL, were involved in the fall patterns. Low roughage intake (OR = 2.48, 95% CI 1.24-4.97), female gender (OR = 2.12, 95% CI 1.48-3.05), the use of a cane (OR = 2.11, 95% CI 1.08-4.10), and medium IADL (OR = 2.02, 95% CI 1.89-2.32) were the top four risk factors.

CONCLUSION

The fall in the rural elderly was mainly due to the poor living and working conditions. Routine fall assessment could address several preventable risk factors to reduce the prevalence and mitigate the harm of falls.

Relationship between Children's Intergenerational Emotional Support and Subjective Well-Being among Middle-Aged and Elderly People in China: The Mediation Role of the Sense of Social Fairness

This study explored the relations between children's intergenerational emotional support and subjective well-being (SWB) among Chinese middle-aged (45-60 years old) and elderly people (over 60 years old) and the mediation effect of the sense of social fairness between such associations. Using the 2017 Chinese General Social Survey dataset, a nationally representative survey, we selected 2413 middle-aged and elderly people who are 45 years and older, who suited the study requirements with 1097 males and 1316 females, which accounts for 45.5% and 54.5%, respectively. The average of age was 61.62 years old (SD = 10.45). The mediation analyses were conducted by multivariate regression and the SPSS macro PROCESS program. The results indicated that there was a significant association between children's intergenerational emotional support and subjective well-being of middle-aged and elderly people (β = 0.0819, p < 0.001). Children's intergenerational emotional support also had an indirect impact on subjective well-being through one path: the mediating role of the sense of social fairness (0.012). Direct effect (0.0699) and mediation effect (0.012) accounting for the total effect proportion was 85.35% and 14.65%, respectively. The findings may offer some meaningful implications for improving subjective well-being of middle-aged and elderly people. Future research should pay attention to the aforementioned factors with more detailed and comprehensive studies.

Depressive Symptoms, Subjective Cognitive Decline, and Subjective Sleep Quality Are Associated with Slips and Falls: Data from the Community Health Survey in Korean Adults

<b><i>Background:</i></b> Identifying the risk factors for falls among the elderly population is arguably one of the most imperative public health issues in the current aging society. <b><i>Objectives:</i></b> This study aimed to determine the associations between depressive symptoms, subjective cognitive decline (SCD), and poor subjective sleep quality and the risk of slips/falls in a Korean older population. <b><i>Methods:</i></b> This cross-sectional study involved 228,340 elderly individuals living in Korea. Measurements included self-reported depressive symptoms, SCD, and self-reported sleep quality. The risk of slips/falls was dichotomized depending on whether slips/falls had occurred during the past year, and the associations between different risk factors and slips/falls were explored. Multiple logistic regression was used to obtain the odds ratios (ORs) and 95% confidence intervals (CIs). Complex sampling methods were used to estimate the weighted value of each participant. <b><i>Results:</i></b> The risk of slips/falls was significantly associated with high levels of depressive symptoms (adjusted OR 1.06, 95% CI: 1.05–1.07) and SCD (adjusted OR 1.33, 95% CI: 1.19–1.50). Regarding each sleep quality component, the adjusted ORs for slips/falls were 1.85 for very poor sleep quality, 1.49 for long sleep latency, 1.04 for &#x3c;5 h of sleep duration, 1.32 for low sleep efficiency, 2.78 for high sleep disturbance, 1.52 for the use of sleep medication ≥3 times a week, and 1.82 for high daytime dysfunction due to sleep problems compared to the respective good sleep conditions. <b><i>Conclusions:</i></b> Our results demonstrated that depressive symptoms, SCD, and poor subjective sleep quality are independent factors affecting the occurrence of slips/falls. Thus, efforts to manage depressive symptoms and cognitive decline early and to improve sleep quality can be an alternative strategy to decrease the likelihood of falls.

Hypothetical Interventions for Falls Among Older Adults: An Application of the Parametric G-Formula

Introduction: Falls, which have a higher incidence and mortality due to accidental injuries, are a major global health challenge. The effects of lifestyle factor, health indicator, psychological condition, and functional status interventions on the risk of falls are unknown and the conventional regression model would not adjust for the confounders. This study aimed to evaluate the 4-year risk of falls on the basis of these hypothetical interventions among Chinese older adults.

Methods: Data were obtained from 9,692 aged 65 years and over older adults in the China Health and Retirement Longitudinal Study wave, from 2011 to 2015. We used the parametric g-formula to evaluate the risk of falls on the basis of independent hypothetical interventions of sleep duration, social activities, smoking status, drinking status, body mass index (BMI), systolic blood pressure (SBP), vision, depression, activities of daily living (ADL), and their different joint intervention combinations.

Results: During the follow-up of 4 years, we documented 1,569 falls. The observed risk of falls was 23.58%. The risk ratios (95% confidence intervals [CIs]) of falls under the intensive hypothetical interventions on increasing sleep duration, participating in more social activities, quit smoking and drinking, reducing BMI and SBP, better vision, alleviating depressive symptoms, and improving ADL capability were 0.93 (0.87–0.96), 0.88 (0.79–0.92), 0.98 (0.95–1.03), 0.97 (0.95–1.02), 0.92 (0.86–1.03), 0.93 (0.87–1.04), 0.86 (0.74–0.91), 0.91 (0.85–0.96), and 0.79 (0.74–0.85), respectively. The feasible and intensive joint hypothetical intervention reduced the 4-year fall risk by 22% (95% CI: 0.52–0.91) and 33% (95% CI: 0.56–0.72), respectively.

Conclusions: Hypothetical interventions for increasing sleep duration, participating in more social activities, better vision, alleviating depressive symptoms, and improving ADL capability help protect older adults from falls. Our findings suggest that a combination of lifestyle factors, health indicators, psychological conditions, and functional status may prove to be an effective strategy for preventing falls among older adults.

Risk of falls in 4 years of follow-up among Chinese adults with diabetes: findings from the China Health and Retirement Longitudinal Study

OBJECTIVES

This study was to determine the incidence of falls and identify baseline factors increased risk for incident falls over time among people with diabetes.

DESIGN

This study was a secondary analysis using the baseline and 4 years of follow-up data from the China Health and Retirement Longitudinal Study (CHARLS).

SETTING

A nationally representative survey of 17 500 Chinese residents aged 45 years and older were recruited in the baseline national survey in 2011. These participants were followed up every 2 years.

PARTICIPANTS

A total of 1238 middle-aged and older adults with diabetes and no history of falls at baseline were included in the current study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Information on incidence of falls and medical treatment resulting from falls were determined by self-report.

RESULTS

The findings showed that the incidence of falls was 29.4% during 4 years of follow-up. Participants with incident falls were younger, were more likely to be women, had lower education level and were less likely to be current drinkers. In addition, former drinkers were 2.22 times more likely to fall. Socially active individuals were 47% less likely to fall compared with those without social activities. Every 5 kg increase in grip strength was associated with a 13% lower risk of falls. A 10 mg/dL higher total cholesterol and 1 mg/dL higher blood urea nitrogen were associated with a 4% and 6% higher risk of falls. Finally, participants with depressive symptoms were 1.47 times more likely to fall compared with those without depressive symptoms.

CONCLUSIONS

These findings underscore the importance of developing a fall prevention programme for those with diabetes, and this programme should address potentially modifiable risk factors, including levels of total cholesterol, blood urea nitrogen, social activity, depressive symptoms and grip strength.

Comparison of Depressive Symptoms and Its Influencing Factors among the Elderly in Urban and Rural Areas: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Depression amongst the elderly population is a worldwide public health problem, especially in China. Affected by the urban-rural dual structure, depressive symptoms of the elderly in urban and rural areas are significantly different. In order to compare depressive symptoms and its influencing factors among the elderly in urban and rural areas, we used the data from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS). A total of 7690 participants at age 60 or older were included in this study. The results showed that there was a significant difference in the prevalence estimate of depression between urban and rural elderly (χ2 = 10.9.76, p < 0.001). The prevalence of depression among rural elderly was significantly higher than that of urban elderly (OR-unadjusted = 1.88, 95% CI: 1.67 to 2.12). After adjusting for gender, age, marital status, education level, minorities, religious belief, self-reported health, duration of sleep, life satisfaction, chronic disease, social activities and having income or not, the prevalence of depression in rural elderly is 1.52 times (OR = 1.52, 95% CI: 1.32 to 1.76) than that of urban elderly. Gender, education level, self-reported health, duration of sleep, chronic diseases were associated with depression in both urban and rural areas. In addition, social activities were connected with depression in urban areas, while minorities, marital status and having income or not were influencing factors of depression among the rural elderly. The interaction analysis showed that the interaction between marital status, social activities and urban and rural sources was statistically significant (divorced: coefficient was 1.567, p < 0.05; social activities: coefficient was 0.340, p < 0.05), while gender, education level, minorities, self-reported health, duration of sleep, life satisfaction, chronic disease, social activities having income or not and urban and rural sources have no interaction (p > 0.05). Thus, it is necessary to propose targeted and precise intervention strategies to prevent depression after accurately identifying the factors' effects.

Fall Efficacy Scale-International cut-off score discriminates fallers and non-fallers individuals who have had stroke

BACKGROUND

Falls, which are common events after stroke, may lead to activity limitations and increased dependence. It is important to identify which commonly employed clinical measures could differentiate individuals, who are fallers from the non-fallers.

AIM

To investigate specific cut-off values of clinical measures that could discriminate fallers and non-fallers individuals with chronic stroke.

METHOD

This cross-sectional study involved 105 community-dwelling individuals with stroke. The primary outcome was report of falls over the last six months. The clinical predictors included measures of mobility (walking speed, stair ascent/descent cadences, time to perform the Timed Up and Go test, and ABILOCO) and the Fall Efficacy Scale - International (FES-I) scores. To identify which measures were able to detect between-group differences, independent Student's t-tests were employed. For measures which were able to discriminate fallers from the non-fallers, the Receiver Operating Characteristics (ROC) and the Area Under the ROC Curve (AUC) were calculated.

RESULTS

Out of the 105 participants (61 men), 41% reported falls over the previous 6 months. Stair ascent cadence, ABILOCO, and FES-I scores significantly differentiated the groups, but only the FES-I demonstrated acceptable discriminatory ability (AUC = 0.71). The optimal FES-I cut-off score was 28 points (sensitivity = 0.71; specificity = 0.57; positive predictive value = 51%; and negative predictive value = 74%).

CONCLUSIONS

The FES-I demonstrated good discriminatory ability to classify individuals with chronic stroke, who were fallers from the non-fallers. The use of the established cut-off value of 28 points is recommended and may help clinical reasoning and decision-making in stroke rehabilitation.

Self-reported vision impairment, vision correction, and depressive symptoms among middle-aged and older Chinese: Findings from the China health and retirement longitudinal study

OBJECTIVE

To investigate associations between vision impairment (VI), vision correction (VC) and depressive symptoms among middle-aged and older Chinese.

METHODS

22 203 participants aged ≥45 years from China Health and Retirement Longitudinal Study 2011 to 2015 were divided into four self-reported VI categories: no VI, distance VI (DVI) only, near VI (NVI) only, and both distance and near VI (DNVI); and four self-reported VI/VC subgroups: VI(+)/VC(-), VI(+)/VC(+), VI(-)/VC(-) and VI(-)/VC(+). Depressive symptoms were evaluated by 10-item Center for Epidemiological Studies Depression Scale (CESD-10).

RESULTS

Compared with no VI, DVI only (OR = 2.12, 95% CI: 1.95, 2.31), NVI only (OR = 1.51, 95% CI: 1.39, 1.63) and DNVI (OR = 2.75, 95% CI: 2.47, 3.07) were associated with higher odds of depressive symptoms. Compared with VI(+)/VC(-), VI(+)/VC(+) (OR = 0.91, 95% CI: 0.83, 0.98), VI (-)/VC(-) (OR = 0.50, 95% CI: 0.48, 0.53) and VI(-)/VC(+) (OR = 0.49, 95% CI: 0.47, 0.54) were associated with lower odds of depressive symptoms. Compared with no VI at baseline, baseline DNVI was significantly associated with higher odds of depressive symptoms after two (OR = 1.48, 95% CI: 1.16, 1.88) and four (OR = 1.32, 95% CI: 1.04, 1.68) years. Baseline depressive symptoms were significantly associated with higher odds of VI after two (OR = 1.53, 95% CI: 1.34, 1.74) and four (OR = 1.54, 95% CI: 1.34, 1.76) years.

CONCLUSION

Adults with DNVI were more likely to report depressive symptoms in the future and those with depressive symptoms were more likely to report VI in the future. VC might be a protective factor for preventing depressive symptoms among adults with VI.

Association of Frailty Status with Risk of Fall among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

OBJECTIVES

To investigate the association between frailty status and risk of fall among middle-aged and older Chinese people.

DESIGN

A nationally representative prospective cohort study.

SETTING AND PARTICIPANTS

The study included 13,877 community-dwelling participants aged 45 years and above from the China Health and Retirement Longitudinal Study.

METHODS

Frailty status was identified by the frailty index of health deficit accumulation. 34 variables at baseline were selected to calculate the frailty index. We excluded participants with incomplete information in construction of the frailty index at baseline. Falls were measured based on the respondents' self-report. We used a logistic regression model to estimate the associations between the frailty status and risk of fall, and subgroup analyses and sensitivity analyses were further conducted.

RESULTS

Of 13,877 participants, 2310 (16.6%) had falls during the observation period. 9027 (65.0%) participants were classified as robust, 4019 (29.0%) participants were classified as pre-frail, and 831 (6.0%) participants were classified as frail. Our results indicated per 0.01 increment in the frailty index was significantly associated with an increased risk of fall among middle-aged and older participants (OR: 1.52, 95%CI: 1.45-1.60). Such association was stronger when frailty was presented as a categorical variable, with an OR of 1.75 (95%CI: 1.59-1.93) for pre-frail and 3.04 (95%CI: 2.60-3.56) for frail. The area under the curve of the logistic model was 0.612 (95%CI: 0.600-0.625). Each 0.01 increment of the frailty index was association with a higher risk of fall among middle-aged (45-59years) participants (OR: 1.44, 95%CI: 1.29-1.60) than among older (≥60 years) participants (OR: 1.28, 95%CI: 1.16-1.41) at baseline (p=0.015 for interaction).

CONCLUSION

Frailty was significantly associated with an increased risk of fall among community-dwelling middle-aged and older people in China. It is necessary to screen and recognize frailty status to prevent falls among middle-aged and older adults.

Effects of Depressive Disorders on Patients Undergoing Primary Total Knee Arthroplasty: A Matched-Control Analysis

BACKGROUND

Studies evaluating the effects of depressive disorders in patients undergoing primary total knee arthroplasty (TKA) are sparse. Therefore, the purpose of this study is to investigate whether patients who have depressive disorders undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) readmission rates, (3) medical complications, (4) implant-related complications, and (5) costs of care.

METHODS

Patients with depressive disorders undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and comorbidities. The query yielded 138,076 patients who had (n = 23,061) or did not have (n = 115,015) depressive disorders. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, and costs of care. A P value less than .003 was considered statistically significant.

RESULTS

Patients who have depressive disorders had significantly longer in-hospital LOS (6.2 days vs 3.1 days; P < .0001). Additionally, study group patients had a higher incidence and odds of readmissions (15.5% vs 12.1%; odds ratio [OR], 1.33; P < 001), medical complications (5.0% vs 1.6%; OR, 3.34; P < .0001), and implant-related complications (3.3% vs 1.7%; OR; 1.97; P < .0001) Study group patients also incurred significantly higher day of surgery ($12,356.59 vs $10,487.71; P < .0001) and 90-day costs ($23,386.17 vs $22,201.43; P < .0001).

CONCLUSION

After adjusting for age, sex, and comorbidities, this study demonstrated that patients who have depressive disorders have increased rates of in-hospital LOS, readmissions, complications, and cost. The study is useful in allowing orthopedists to adequately educate patients of potential complications which may occur.

Depressive symptoms in individuals with family members requiring ADL assistance

BACKGROUND

The number of patients with depressive symptoms worldwide is increasing steadily, and the prevalence of depression among caregivers is high. Therefore, the present study aimed to identify the effects of individuals' caregiving status with respect to their family members requiring activities of daily living (ADLs) assistance on depressive symptoms among those aged 45 or over.

METHODS

Data were collected from the 2006-2016 using the Korean Longitudinal Study of Aging surveys. Participants were categorized into three groups based on their caregiving status with respect to family members requiring ADL assistance: whether they provided the assistance themselves, whether the assistance was provided by other caregivers, or whether no assistance was required. We analyzed the generalized estimating equation model and subgroups.

RESULTS

A total of 3744 men and 4386 women were included for the analysis. Men who cared for family members requiring ADL assistance had higher depressive symptoms than those with family members who did not require ADL assistance. Among women, participants who had family members requiring ADL assistance that they themselves or others were providing had higher depressive symptoms than those without family members requiring ADL assistance. Subgroup analysis was conducted based on age, job status, regular physical activities, participation status in social activities, and the number of cohabiting generations.

CONCLUSIONS

The study results indicated higher depressive symptoms among those with family members requiring ADL assistance and those who care for such family members themselves. This suggests that an alternative to family caregiving is necessary, especially for the elderly, regardless of caregiver sex.

Gender, socioeconomic, medical, and environmental factors related to domestic accidents of the elderly in Spain. Findings of a national survey

Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10-1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35-2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.