make judgements and coordinate Falls & Falls Injury Prevention Service Newsletter │ December 2014/Januarymovements. 2015 Depression and Falls With an estimated 15-20% of people over 65 suffering from some form of depression (Biderman et al1 2002), the link between depression and an increased risk of falling should not be overlooked. According to Beyond Blue (www.beyondblue.org.au) depression is more than a feeling of sadness or a low mood. Depression is a serious illness that affects you mentally and physically. The symptoms of depression which increase the risk of falling include: - fear of falling - poor cognitive functioning, mainly in executive function, attention and processing speed. - poor appetite/ hydration and weight loss (Laboni et al2 2013) It is often accompanied by anxiety. Fearful people often walk slowly (loss of stability), have shorter strides (stiffening and postural over adjustment), a wider base, poor coordination and higher gait variability (Laboni et al 2013). These changes result in the inability to pay attention to environmental factors while walking. Poor executive function processes affect the ability to compensate for age related motor and sensory function changes leading to postural instability, impairment of activities of daily living and falls3 . Poor nutrition and weight loss put individuals at risk of falling from deconditioning and loss of muscle mass with an inability to weight bear. Falls result from a loss of balance and coordination. 1 Continued weight loss and inactivity can lead to postural hypotension: a sudden drop in blood pressure when changing positions which leads to dizziness and fainting. Poor nutrition also impairs the brains ability to function and process information, 2 3 Fear of Falling is described as an excessive and disabling emotional response to falling resulting in avoidance of activity. Biderman, A., Cwikel, J., Fried, A., and Galinsky, D. (2002) Depression and falls among community dweling elderly people: a search for common risk factors. J Epidemol Community Health, 56:631-636. Laboni, A., Phil, D., and Flint, J. (2013). The complex Interplay of Depression and Falls in older Adults: A clinical review. Am J Geriatr Psychiatry, 21:5, May 2013, pg 484. ProQuest Central. Dehydration is common in the elderly as their thirst drive lessens over time. However, this is exacerbated with depression especially with severe depression where fluid consumption is restricted by the individual due to inactivity and forgetfulness. Dehydration affects cognitive ability and motor function. TREATMENT Biderman et al report that regular exercise and leisure activities are important for developing a sense of positive well-being and can lead to lower levels of depression and anxiety in individuals. Better nutrition (including supplements), and medical intervention to treat depressive symptoms all combine to help decrease the falls risk for individuals. Getting appropriate treatment from mental health professionals is important in combination with input from the General Practitioner. Remember if you are concerned about anyone who may be depressed you can call Beyond Blue on 1300 224 636 24 hours a day, 7 days a week or they can see their General Practitioner for help. Montero-Odasso, M., Verghese, J., Beauchet, O., and Hausdorff, J. (2012) Gait and Cognition: A complementary approach to understanding brain function and the risk of falling. JAGS. 60:2127-2136. To make a referral, contact Community Health Intake (CHI): Phone: 02 6207 9977 Fax: CHI referral form to 02 6205 2611 Email: CHI referral form to Chiintake@act.gov.au CHI referral form can be located at www.health.act.gov.au/community health