The Mediating Effect of Frailty in the Relationship between Depression and Falls among Older People Living Alone in Korea
Abstract
Background: We explored the potential mediating role of frailty in the relationship between depression and falls.
Methods: The participants were 1,408 community-dwelling older people living alone in South Korea. The potential mediating role of frailty in the relationship between depression and falls was evaluated through univariate and multivariate logistic regression. Baron and Kenny’s three-step criteria for mediation were used to examine the mediating effect.
Results: Frailty fully mediated the association between severe depression and falls in univariate (t=11.58, P<.05) and multivariate (t=10.42, P<.05) analyses.
Conclusion: Frailty is a valuable target for fall interventions in severely depressed older people living alone.
1. Lee IS, Jeong IS (2012). Frailty level and health-related characteristics among par-ticipants of a tailored home visiting ser-vice. J Korean Geriatr Soc, 16(2):74–83.
2. Ministry of Health, Welfare and Family Af-fairs (2009). 2008 Living profiles of older people survey: A national report on the living status and welfare needs of older adults. Policy report. Seoul: Ministry of Health and Welfare and Family, Keimyung University Industry-Academic Cooperation Foundation. Report No.: 11-1351000-000316-12.
3. Jung HW, Jang IY, Lee YS, et al (2016). Prevalence of frailty and aging-related health conditions in older Koreans in ru-ral communities: a cross-sectional analysis of the Aging study of Pyeongchang rural area. J Korean Med Sci, 31:345-352.
4. Abellan van KG, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B (2008). The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging, 12:29–37.
5. Fried LP, Tangen CM, Walston J, et al (2001). Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 56(3):M146–156.
6. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012). Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc, 60:1487-1492.
7. Ensrud KE, Ewing SK, Taylor BC, et al (2008). Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med, 168:382–389.
8. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012). Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc, 60(8):1487-1492.
9. Kharicha K, Iliffe S, Harari D, Swift C, Gillmann G, Stuck AE (2007). Health risk appraisal in older people 1: Are older people living alone an "at-risk" group? Br J Gen Pract, 57(537):271–276.
10. Prince MJ, Harwood RH, Blizard RA, et al (1997). Social support deficits, loneliness and life events as risk factors for depres-sion in old age. The Gospel Oak Project VI. Psychol Med, 1997; 27: 323–32.
11. Katz IR (2004). Depression and frailty: the need for multidisciplinary research. Am J Geriatr Psychiatry, 12(1):1–6.
12. Satake S, Senda K, Hong YJ, et al (2016). Validity of the Kihon checklist for as-sessing frailty status. Geriar Gerontolo Int, 16(6): 709-715.
13. Arial H, Satake S (2015). English translation of the Kihon Checklist. Geriatr Gerontol Int, 15:518-519.
14. Hirose J, Nagata T, Ogushi M, et al (2017). Validation of each category of Kihon Checklist for assessing physical function-ing, nutrition and cognitive status in a community-dwelling older Japanese co-hort. Epidemiology, 7(5): 326.
15. Menant JC, Wong AK, Trollor IN, Close JC, Lord SR (2016). Depressive symp-toms and orthostatic hypotension are risk factors for unexplained falls in community-living older people. J Am Ger-iatr Soc, 64(5):1073–1078.
16. Lee WJ, Cheng YY, Liu JY, Yang KC, Jeng SY (2011). Living alone as a red flag sign of falls among older people in rural Tai-wan. Journal of Clinical Gerontology and Geri-atrics, 2(3):76–79.
17. Lohman MC, Dumenci L, Mezuk B (2016). Depression and frailty in late life: evi-dence for a common vulnerability. J Ger-ontol B Psychol Sci Soc Sci, 71(4):630–640.
18. Paulson D, Lichtenberg PA (2013). Vascular depression: An early warning sign of frailty. Aging Ment Health, 17(1):85–93.
19. McAdams-DeMarco MA, Suresh S, Law A, et al (2013). Frailty and falls among adult patients undergoing chronic hemodialy-sis: A prospective cohort study. BMC Nephrol, 14:224.
20. Kron M, Loy S, Sturm E, Nikolaus T, Beck-er C (2003). Risk indicators for falls in in-stitutional frail elderly. Am J Epidemiol, 158(7):645–653.
21. Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP (2005). The association be-tween obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc, 53:927–934.
22. Murad K, Kitzman DW (2012). Frailty and multiple comorbidities in the elderly pa-tient with heart with heart failure: implica-tions for management. Heart Fail Rev, 17:581–588.
23. Shen SS, Chu JJ, Cheng Let, al (2016). Ef-fects of a nutrition plus exercise pro-gramme on physical function in sarcope-nic obese elderly people: study protocol for a randomized controlled trial. BMJ Open, 6(9): e012140. doi: 10.1136/bmjopen-2016-012140.
24. Bollwein J, Diekmann R, Kaiser MJ, et al (2013). Distribution but not amount of protein intake is associated with frailty: a cross-sectional investigation in the region of Nurnberg. Nutr J, 12:109.
25. MacKinnon DP, Fairchild AJ, Fritz MS (2007). Mediation analysis. Annu Rev Psy-chol, 58: 593-614.
26. Living alone elderly status. Korean Statistical Information Service (KOSIS) (2013). Re-trieved June 4, 2017 from http://kosis.kr/statHtml/statHtml.do?orgId=616&tblId=DT_61601_K000048&vw_cd=MT_ZTITLE&list_id=210_210A_616_61601_K&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=E1#
27. Lee I, Park YI, Park E , Lee SH , Jeong IS (2011). Validation of instruments to clas-sify the frailty of the elderly in communi-ty. J Korean Acad Community Health Nurs, 22:302-314.
28. Sheikh JI, Yesavage JA (1986). Geriatric De-pression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol, 5(1/2):165–173.
29. Freedman LS, Schatzkin A (1992). Sample size for studying intermediate endpoints within intervention trails or observational studies. Am J Epidemiol, 136(9): 1148-1159.
30. Zhu Y, Liu Z, Wang Y, et al (2016). Agree-ment between the frailty index and phe-notype and their associations with falls and overnight hospitalizations. Arch Ger-ontol Geriatr, 66: 161-165.
2. Ministry of Health, Welfare and Family Af-fairs (2009). 2008 Living profiles of older people survey: A national report on the living status and welfare needs of older adults. Policy report. Seoul: Ministry of Health and Welfare and Family, Keimyung University Industry-Academic Cooperation Foundation. Report No.: 11-1351000-000316-12.
3. Jung HW, Jang IY, Lee YS, et al (2016). Prevalence of frailty and aging-related health conditions in older Koreans in ru-ral communities: a cross-sectional analysis of the Aging study of Pyeongchang rural area. J Korean Med Sci, 31:345-352.
4. Abellan van KG, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B (2008). The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging, 12:29–37.
5. Fried LP, Tangen CM, Walston J, et al (2001). Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 56(3):M146–156.
6. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012). Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc, 60:1487-1492.
7. Ensrud KE, Ewing SK, Taylor BC, et al (2008). Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med, 168:382–389.
8. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012). Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc, 60(8):1487-1492.
9. Kharicha K, Iliffe S, Harari D, Swift C, Gillmann G, Stuck AE (2007). Health risk appraisal in older people 1: Are older people living alone an "at-risk" group? Br J Gen Pract, 57(537):271–276.
10. Prince MJ, Harwood RH, Blizard RA, et al (1997). Social support deficits, loneliness and life events as risk factors for depres-sion in old age. The Gospel Oak Project VI. Psychol Med, 1997; 27: 323–32.
11. Katz IR (2004). Depression and frailty: the need for multidisciplinary research. Am J Geriatr Psychiatry, 12(1):1–6.
12. Satake S, Senda K, Hong YJ, et al (2016). Validity of the Kihon checklist for as-sessing frailty status. Geriar Gerontolo Int, 16(6): 709-715.
13. Arial H, Satake S (2015). English translation of the Kihon Checklist. Geriatr Gerontol Int, 15:518-519.
14. Hirose J, Nagata T, Ogushi M, et al (2017). Validation of each category of Kihon Checklist for assessing physical function-ing, nutrition and cognitive status in a community-dwelling older Japanese co-hort. Epidemiology, 7(5): 326.
15. Menant JC, Wong AK, Trollor IN, Close JC, Lord SR (2016). Depressive symp-toms and orthostatic hypotension are risk factors for unexplained falls in community-living older people. J Am Ger-iatr Soc, 64(5):1073–1078.
16. Lee WJ, Cheng YY, Liu JY, Yang KC, Jeng SY (2011). Living alone as a red flag sign of falls among older people in rural Tai-wan. Journal of Clinical Gerontology and Geri-atrics, 2(3):76–79.
17. Lohman MC, Dumenci L, Mezuk B (2016). Depression and frailty in late life: evi-dence for a common vulnerability. J Ger-ontol B Psychol Sci Soc Sci, 71(4):630–640.
18. Paulson D, Lichtenberg PA (2013). Vascular depression: An early warning sign of frailty. Aging Ment Health, 17(1):85–93.
19. McAdams-DeMarco MA, Suresh S, Law A, et al (2013). Frailty and falls among adult patients undergoing chronic hemodialy-sis: A prospective cohort study. BMC Nephrol, 14:224.
20. Kron M, Loy S, Sturm E, Nikolaus T, Beck-er C (2003). Risk indicators for falls in in-stitutional frail elderly. Am J Epidemiol, 158(7):645–653.
21. Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP (2005). The association be-tween obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc, 53:927–934.
22. Murad K, Kitzman DW (2012). Frailty and multiple comorbidities in the elderly pa-tient with heart with heart failure: implica-tions for management. Heart Fail Rev, 17:581–588.
23. Shen SS, Chu JJ, Cheng Let, al (2016). Ef-fects of a nutrition plus exercise pro-gramme on physical function in sarcope-nic obese elderly people: study protocol for a randomized controlled trial. BMJ Open, 6(9): e012140. doi: 10.1136/bmjopen-2016-012140.
24. Bollwein J, Diekmann R, Kaiser MJ, et al (2013). Distribution but not amount of protein intake is associated with frailty: a cross-sectional investigation in the region of Nurnberg. Nutr J, 12:109.
25. MacKinnon DP, Fairchild AJ, Fritz MS (2007). Mediation analysis. Annu Rev Psy-chol, 58: 593-614.
26. Living alone elderly status. Korean Statistical Information Service (KOSIS) (2013). Re-trieved June 4, 2017 from http://kosis.kr/statHtml/statHtml.do?orgId=616&tblId=DT_61601_K000048&vw_cd=MT_ZTITLE&list_id=210_210A_616_61601_K&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=E1#
27. Lee I, Park YI, Park E , Lee SH , Jeong IS (2011). Validation of instruments to clas-sify the frailty of the elderly in communi-ty. J Korean Acad Community Health Nurs, 22:302-314.
28. Sheikh JI, Yesavage JA (1986). Geriatric De-pression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol, 5(1/2):165–173.
29. Freedman LS, Schatzkin A (1992). Sample size for studying intermediate endpoints within intervention trails or observational studies. Am J Epidemiol, 136(9): 1148-1159.
30. Zhu Y, Liu Z, Wang Y, et al (2016). Agree-ment between the frailty index and phe-notype and their associations with falls and overnight hospitalizations. Arch Ger-ontol Geriatr, 66: 161-165.
| Files | ||
| Issue | Vol 51 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i3.8936 | |
| Keywords | ||
| Accidental falls Depression Frail elderly Health service Living independent | ||
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How to Cite
1.
Kim Y-H, Cho JM. The Mediating Effect of Frailty in the Relationship between Depression and Falls among Older People Living Alone in Korea. Iran J Public Health. 2022;51(3):596-605.
