Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study

Abstract

Background: Anxiety and depressive symptoms are associated with fear of falling and fear of falling-related activity restrictions. However, it remains unknown whether anxiety or depressive symptoms alone could predict fear of falling and activity restrictions in older adults. We sought to determine if anxiety and depressive symptoms alone could be an independent predictor of fear of falling and activity restrictions in community-dwelling older adults.

Methods: This longitudinal analysis used waves 5 (time 1, [T1]) and 6 (time 2, [T2], 1 year from T1) data (N = 6376) from the National Health and Aging Trends Study. The Generalized Anxiety Disorder Scale 2 and Patient Health Questionnaire 2 were used to assess anxiety and depressive symptoms, respectively. Interview questions included demographics, health-related data, and fall worry levels (no fear of falling, fear of falling but no activity restrictions, and activity restrictions). Using multinomial logistic regression models, we examined whether anxiety and depressive symptoms (T1) predicted fear of falling and activity restrictions (T2).

Results: In wave 5 (T1, mean age: 78 years, 58.1% female), 10 and 13% of participants reported anxiety and depressive symptoms. About 19% of participants experienced fear of falling but not activity restrictions, and 10% of participants developed activity restrictions in wave 6 (T2), respectively. Participants with anxiety symptoms at T1 had a 1.33 times higher risk of fear of falling (95% CI = 1.02-1.72) and 1.41 times higher risk of activity restrictions (95% CI = 1.04-1.90) at T2. However, having depressive symptoms did not show any significance after adjusting for anxiety symptoms.

Conclusions: Anxiety symptoms seemed to be an independent risk factor for future fear of falling and activity restrictions, while depressive symptoms were not. To prevent future fear of falling and activity restrictions, we should pay special attention to older individuals with anxiety symptoms.

Keywords: Activity restrictions; Anxiety symptoms; Depressive symptoms; Fall; Fear of falling; Older adult.

Fig. 1

Results of anxiety and depressive symptoms on fall worry levels without controlling for each other. Legends: * P < .05, ** P < .01, ***P < .001. Abbreviation: FOF = fear of falling; FAR = fear of falling related activity restrictions. Model 1 adjusted for fall worry level at T1; Model 2: Model 1 + demographic covariables (age, gender, race/ethnicity, education, living arrangement); Model 3: Model 2 + health-related covariables (BMI, pain, ADL, IADL, hospitalization, falls, balance, number of chronic illnesses)

Fig. 2

Results of anxiety and depressive symptoms on fall worry levels controlling for each other. Legends: * P < .05, ** P < .01, ***P < .001. Abbreviation: FOF = fear of falling; FAR = fear of falling related activity restrictions. Model 1 adjusted for fall worry levels and depressive symptoms/anxiety symptoms at T1; Model 2: Model 1 + demographic covariables (age, gender, race/ethnicity, education, living arrangement); Model 3: Model 2 + health-related covariables (BMI, pain, ADL, IADL, hospitalization, falls, balance, number of chronic illnesses)