Depressive symptomatology as a risk factor for falls in older people: Systematic review and meta-analysis

Objectives To conduct a systematic literature review and meta-analysis to evaluate studies that have addressed depressive symptoms as a risk factor for falls in older people. Design Systematic review with meta-analysis. Setting Community and residential care. Participants Individuals aged 60 and older. Measurements Depressive symptoms, incidence of falls. Results Twenty-five prospective studies with a total of 21,455 participants met inclusion criteria for the systematic review. Twenty studies met criteria for the meta-analyses. Recruitment of participants was conducted randomly or by approaching groups with identified healthcare needs. Eleven measures were used to assess depressive symptoms, and length of follow-up for falls ranged from 90 days to 8 years. Reporting of antidepressant use was variable across studies. The pooled effect of 14 studies reporting odds ratios (ORs) indicated that a higher level of depressive symptoms at baseline resulted in a greater likelihood of falling during follow-up (OR = 1.46, 95% confidence interval (CI) = 1.27-1.67, P <.001, I² = 77.2%). In six studies reporting relative risks (RRs) or hazard ratios, a higher level of depressive symptoms at baseline resulted in a greater likelihood of falling during follow-up (RR = 1.52, 95% CI = 1.19-1.84, P <.001). There was no difference between community samples and those with identified healthcare needs with respect to depressive symptoms being a risk factor for falls. Conclusion Depressive symptoms were found to be consistently associated with falls in older people, despite the use of different measures of depressive symptoms and falls and varying length of follow-up and statistical methods. Clinicians should consider management of depression when implementing fall prevention initiatives, and further research on factors mediating depressive symptoms and fall risk in older people is needed.