Depressive Symptoms, Non-Injurious Falls, and Fall-Related Injuries Among Community-Dwelling Older Adults: Findings from a Structural Equation Model

Non-injurious falls (NIFs) and fall-related injuries (FRIs) compromise older adults’ ability to engage in activities and may generate chronic stress resulting in increased depressive symptoms. Depressive symptoms may also affect executive functioning and behaviors, resulting in increased NIF and/or FRI risk.

Using the 2006-10 waves of the Health and Retirement Study with 13,439 U.S., community-dwelling adults ages 65 and older, “cross-lagged panel” analyses with structural equation modeling were used to separately evaluate temporal associations between depressive symptoms and NIFs and FRIs. Structural coefficients of pathways between NIFs/FRIs and depressive symptoms were estimated, controlling for baseline poor health status, perceived social support, and social cohesion.

Both the NIF (CFI: 0.942, RMSEA: 0.026) and FRI (CFI: 0.944, RMSEA: 0.025) models had acceptable fit. Those with prior NIFs/FRIs had increased odds of future NIFs/FRIs and previous depressive symptoms predicted future depressive symptoms. Depressive symptoms predicted future NIFs (probit regression coefficients of 0.69 for 2006-2008 and 0.82 for 2008-2010, p<0.001), though NIFs did not predict future depressive symptoms. Depressive symptoms predicted future FRIs (0.95, p<0.001 for 2006-2008 and 1.17, p<0.001 for 2008-2010) and FRIs predicted future depressive symptoms (0.01, p=0.04 for 2006-2008).

A one-unit increase in depressive symptoms was associated with a more than 200% increase in the odds of future NIFs and FRIs. However, NIFs and FRIs were not associated with greater odds of future increased depressive symptoms. Prevention efforts should include emotional health as a main falls risk factor and geriatric evaluations should emphasize the depressive symptoms—falls relationship.