Relationship between Depression and Falls among Nursing Home Residents: an Integrative Review (Preprint)

Abstract

Depression is a highly prevalent psychopathological condition among older adults, particularly those institutionalised in nursing homes (NHs). Unfortunately, it is poorly identified and diagnosed. NH residents are twice as likely to fall as community-dwelling older adults. There is a need for more knowledge about the mechanisms and relationships between depression and falls.

Identify, analyse and synthesise primary research on the relationships between depression and falls among NH residents.

This review followed the steps recommended by Coleen and Remington (2020). A literature search, conducted in October 2023, examined the following bibliographic databases for quantitative, qualitative and mixed-methods studies: Medline ALL Ovid, Embase.com, CINAHL with Full Text EBSCO, APA PsycInfo Ovid, Web of Science Core Collection, ProQuest Dissertations & Theses A&I, and the Cochrane Library. Additional hand-searches were performed using backward citation tracing. The Newcastle–Ottawa Scale and the Appraisal tool for Cross-Sectional Studies were used to evaluate study quality.

The review included seven quantitative studies published in seven different countries from three continents; six were cross-sectional studies, and one was a prospective cohort study. Results suggested high frequencies of depressive symptoms and falls among older adults living in NHs, and depressive symptoms were found to be associated with and a risk factor for falls. The 15-item and 10-item versions of the Geriatric Depression Scale were the most used measurement tools, followed by the Cornell Scale for Depression in Dementia and the Resident Assessment Instrument-Minimum Data Set 2.0. The prevalence of depression was heterogeneous, varying from 21.5% (Kioh et al.) to 47.7% (Kron et al.) of NH residents. The studies used heterogeneous descriptions of a fall, and some considered the risk of falls, recurrent fallers and near falls in their data. The prevalence of fallers was disparate, varying from 17.2% to 63.1%. All the studies retained except Khater et al.’s reported a relationship between depression and falls or the risk of falls based on a significant odds ratio. Nineteen potential risk factors other than depression were associated with falls among NH residents, for example, respiratory illnesses (OR = 3.38, 95%CI: 1.11–10.30; P< .05), more than one fall in the past 12 months (OR = 3.90, 95%CI: 1.72–8.8; P< .05), and a history of falls in the last 180 days (OR = 5.2, 95%CI: 3.2–8.5; P<.001).

There is a paucity of research examining falls among older adults with depressive symptoms in NHs. These findings should alert nurses to the need to consider depression as a risk factor in their work to prevent falls. More research is needed to better understand fall risk among depressive NH residents.

RR2-10.2196/46995