Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France.
J Nutr Health Aging. 2013 Feb;17(2):152-7. doi: 10.1007/s12603-012-0370-z.
Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined. In addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied.
Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1±5.4years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score≥1) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over", "Accidental falls", "Depressive disorder" and "Reccurence". The search also included the reference lists of the retrieved articles.
A total of 19.0% (n=494) participants were recurrent fallers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P<0.001), and was significantly associated with recurrent falls (Odd ratio (OR)=1.82 with P<0.001 for full model; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic review found only four other studies on this topic, three of them examining the association of depressive symptoms with recurrent falls using 30-item or 15-item GDS. All studies showed a significant association of depressive symptoms with recurrent falls.
The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrent falls. This association of depressive symptoms with recurrent falls was confirmed by the systematic review. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS.
建议对复发性跌倒者进行抑郁症状筛查。与 30 项和 15 项老年抑郁量表（GDS）相比，4 项 GDS 更容易管理，且用时更短。异常的 4 项 GDS 评分与复发性跌倒之间的关系尚未得到检验。此外，虽然与抑郁症状相关的步态不稳已广为人知，但与复发性跌倒的关系却很少有研究。
1）使用来自法国里昂健康保险健康检查中心（HEC）的原始数据，在社区居住的老年人中检验异常的 4 项 GDS 评分与复发性跌倒之间的关系，2）对检查抑郁症状与老年人复发性跌倒之间关系的研究进行系统综述。
首先，基于横断面设计，在法国里昂 HEC 招募了 2594 名社区居民（平均年龄 72.1±5.4 岁；49.8%为女性）。4 项 GDS 评分（评分≥1 为异常）和复发性跌倒（即过去一年中发生 2 次或以上跌倒）为主要结局。其次，于 2012 年 5 月 28 日进行了一项无日期限制的英语和法语 Medline 文献检索，使用以下医学主题词（MeSH）术语“老年或 80 岁以上”、“意外跌倒”、“抑郁障碍”和“复发”。检索还包括检索到的文章的参考文献列表。
在横断面研究中，共有 19.0%（n=494）的参与者为复发性跌倒者。与非复发性跌倒者相比，异常的 4 项 GDS 评分在复发性跌倒者中更为常见（44.7%对 25.0%，P<0.001），并且与复发性跌倒显著相关（全模型的优势比（OR）=1.82，P<0.001；逐步向后模型的 OR=1.86，P<0.001）。除本研究外，系统综述仅发现另外四项关于该主题的研究，其中三项使用 30 项或 15 项 GDS 检查抑郁症状与复发性跌倒之间的关系。所有研究均显示抑郁症状与复发性跌倒之间存在显著关联。
本横断面研究显示异常的 4 项 GDS 评分与复发性跌倒之间存在关联。系统综述证实了这种抑郁症状与复发性跌倒之间的关联。基于这些结果，我们建议复发性跌倒风险评估应包括使用 4 项 GDS 对抑郁症状进行系统筛查。
