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

抑郁症老年人跌倒风险增加的机制：因果中介分析

基本信息

批准号：
9805156
负责人：
Matthew Christopher Lohman
金额：
$ 14.47万
依托单位：
UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-08-01 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9805156
关键词：
Activities of Daily Living Acute Address Adult Affective Symptoms Aging Antidepressive Agents Biological Aging Chronic Disease Clinical Cognition Cohort Studies Communities Data Data Set Development Diagnostic Elderly Ensure Environment Environmental Hazards Evaluation Event Fall injury Fall prevention Fatal injury Fatigue Foundations Gait Goals Growth Health Health Services Health and Retirement Study Hospital Costs Impaired cognition Individual Injury Intervention Knowledge Lead Link Literature Longitudinal cohort study Major Depressive Disorder Mediating Mediation Mediator of activation protein Medical Medical Care Costs Mental Depression Mental Health Mental disorders Muscle Weakness Muscular Atrophy Pathway interactions Personal Satisfaction Pharmaceutical Preparations Physical activity Physiological Physiology Policies Population Prevalence Prevention Prevention strategy Primary Health Care Process Psychiatric therapeutic procedure Public Policy Quality of life Recovery Reporting Research Research Priority Resources Risk Risk Factors Role Social Network Social support Surveys Symptoms Syndrome Time United States National Institutes of Health Work aged associated symptom clinical effect clinically significant cognitive development cohort cost depressive symptoms disability epidemiology study experience fall risk falls frailty functional decline functional disability geriatric depression human old age (65+)improved instrumental activity of daily living modifiable risk mortality mortality risk muscle form novel

项目摘要

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.

项目摘要该项目的目的是调查和量化主要关联抑郁症，临床上显着的抑郁症状和跌落，使用来自全国性的大型数据美国老年人的代表性纵向队列研究。跌倒通常会导致伤害，残疾，大量的卫生服务成本，是65岁及以上成年人与伤害有关的主要原因。从跌倒的风险和从跌倒的风险取决于几个因素，包括环境危害，生理脆弱性，认知，药物，心理健康和社会支持。而广泛的研究文献描述了环境和生理在秋季风险中的作用，对心理健康的作用知之甚少。有证据表明患有重度抑郁症的人（最常见的精神健康障碍在老年人中）可能会出现意外跌倒的可能性多达四倍，更有可能由于跌倒而遭受伤害，其受伤比不沮丧的对手。抑郁症的几个关联已被认为是该关联的潜在介体或主持人，例如抗抑郁药药物使用，认知障碍，脆弱和社交网络减少，但相对重要性这些机制尚不清楚。该项目将通过识别和使用新的因果中介分析，量化抑郁和跌倒之间的关键机械途径方法。这项研究将使用来自全国代表性健康和退休研究的纵向数据从2006年到2010年，以解决以下特定目的：目标1和2：确定亲戚和主要抑郁症（临床意义抑郁症）之间关联的绝对程度症状和跌倒风险是由脆弱，认知障碍和抗抑郁药的介导的。目标3：估计抑郁症对功能能力的直接和串行介导的影响（工具活动瀑布的日常生活和日常生活的活动）。通过提供相对和绝对风险的证据与抑郁症相关的跌倒，这项研究将提供两个互补水平的关键信息。第一的，描述不同秋季机制的相对影响将为综合的发展提供信息治疗老年人的抑郁症的策略，易受跌倒和与跌倒有关的伤害。第二，由提供从抑郁到跌倒和与跌倒相关的功能障碍的不同路径的定量证据，该项目将为旨在预防秋季预防的政策和策略的制定和优先级提供信息总体而言，老年人。