Iaboni Andrea, Banez Carol, Lam Robert, Jones Simon A, Maki Brian E, Liu Barbara A, Flint Alastair J
Department of Psychiatry, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Falls Prevention Program, University Health Network, Toronto, Ontario, Canada.
Am J Geriatr Psychiatry. 2015 Oct;23(10):1088-97. doi: 10.1016/j.jagp.2015.02.006. Epub 2015 Feb 16.
To examine whether depression predicts less improvement in fear of falling and falls efficacy in older adults attending a falls prevention program (FPP).
Using a prospective observational design in an academic medical center, the authors studied 69 nondemented adults aged 55 years or older (mean age: 77.8±8.9 years) who had experienced at least one fall in the previous year and who attended the FPP. The primary outcome variable was change in severity of fear of falling during the FPP. Secondary outcome variables were change in falls efficacy and fear-related restriction of activities during the FPP. Independent variables were baseline depressive disorders and depressive symptom severity.
Twenty-one of 69 study participants (30.4%) had a depressive disorder at baseline. Depressive disorder and depressive symptoms were not associated with change in severity of fear of falling or restriction of activity. On the other hand, depressive disorder was associated with improvement in falls efficacy, although this finding was not significant in multivariate analysis. Among participants with a depressive disorder, improvement in falls efficacy was significantly correlated with improvement in depressive symptoms.
There was no association between baseline depression and change in fear of falling in this FPP. The correlation between improvement in depressive symptoms and improvement in falls efficacy raises the question as to whether a cognitive-behavioral intervention that simultaneously targets both depression and falls efficacy would be a useful component of a FPP.
探讨在参加预防跌倒项目（FPP）的老年人中，抑郁是否预示着在跌倒恐惧和跌倒效能方面改善较少。
作者在一家学术医疗中心采用前瞻性观察设计，研究了69名年龄在55岁及以上（平均年龄：77.8±8.9岁）的非痴呆成年人，这些人在前一年至少经历过一次跌倒且参加了FPP。主要结局变量是FPP期间跌倒恐惧严重程度的变化。次要结局变量是FPP期间跌倒效能的变化以及与恐惧相关的活动受限情况。自变量是基线抑郁障碍和抑郁症状严重程度。
69名研究参与者中有21名（30.4%）在基线时有抑郁障碍。抑郁障碍和抑郁症状与跌倒恐惧严重程度的变化或活动受限无关。另一方面，抑郁障碍与跌倒效能的改善有关，尽管这一发现在多变量分析中并不显著。在患有抑郁障碍的参与者中，跌倒效能的改善与抑郁症状的改善显著相关。
在这个FPP中，基线抑郁与跌倒恐惧的变化之间没有关联。抑郁症状改善与跌倒效能改善之间的相关性提出了一个问题，即同时针对抑郁和跌倒效能的认知行为干预是否会成为FPP的一个有用组成部分。
