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Senior Health

Falls - Threat to Independence Part 2

Mental Health Challenges

Psychological factors related to falls are clear throughout the literature but it remains unclear whether the chicken (fall) or the egg (mental health disorder) came first. Does the fall cause depression, anxiety or other mental disorder? Or is the mental disorder with accompanying symptoms such as slowed movement, lack of concentration or impaired or unsteady gait and balance associated with a number of mental health disorders to blame? Regardless, falls represent a significant threat to the health, wellbeing and independence of older adults. As health care and social service professionals, we need to understand and address the interrelated risks through targeted screening that include primarily physical, psychological and environmental factors.

According to researchers,mental health disorders (e.g.,depression, fear of falling) often associated with falls are potentially more debilitating than sustaining an actual fall. Several studies indicate depression anddepression symptoms linked to falling or the fear of falling, including anxiety, loss of confidence (self-efficacy) in mobility can result in an older adult restricting activity levels to avoid falling for the first time. Reduced activity levels often lead to deconditioning, diminished health and function, and potentially may lead to compromising independence. Although mental health disorders are not part of natural aging, recent National Institute of Mental Health (NIMH) studies report that 13 to 27 percent of older adults have subclinical depression (symptoms do not meet the criteria for major depression) associated with "increased risk of major depression, physical disability, medical illness, and high use of health services."

Addressing Mental Health Disorders and Fall Risks - Health care and social service professionals understand that mental health disorders in older adults are sometimes not recognized or symptoms are not reported to care providers. As health care and social service professionals, we understand that growing older may expose older adults to a variety of psychosocial challenges. Chronic illness, death or loss of significant others, overwhelming caregiving responsibilities, social isolation or lack of social support, and loss of independence are some of life's challenges that may trigger mental health disorders in older adults.

Targeted Screening - With the focus of this month's Gero Gems on encouraging health care and social service professionals to assess and address mental health,we emphasize the importance of conducting targeted screening. A variety of effective screening tools are available to assess depression, anxiety, and fear of falling. The Geriatric Depression Scale (GDS) (30 questions) is a valid and reliable tool for use in community dwelling older adults and a short form of the GDS is available (15 questions) free,online that may be administered in less than ten minutes. To test for anxiety, there are several tools available including the Short Anxiety Screening Test (SAST), a brief questionnaire (10 questions) that can be used as an interview, self-report or be administered in less than ten minutes.

Although aging is not a risk for developing mental health problems, some older adults develop mental health disorders that may lead to increased risk for falls. Mental health promotion through screening and referral for treatment, as needed, can be a significant fall risk reduction effort for all who work with older adults.

Recommended Resources- Evelyn's Picks Center for Disease Control and Prevention. Falls in Older Adults. Information on preventing injuries at home and at leisure. 

Gillespie, L. & Handoll, G (2009). Prevention of falls and fall-related injury in older people. Cochrane Corner. Injury Prevention, 15: 354-355. 

GERO GEMS is a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

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Last Reviewed: Aug 30, 2010

Evelyn L Fitzwater, DSN, RN Evelyn L Fitzwater, DSN, RN
Associate Professor Emerita
Associate Director of the
College of Nursing
University of Cincinnati