Depression - AND its treatments - are fall risks
Dr. Eleanor Barbera
Feeling “down” takes on a wicked double-meaning for some seniors. Even conscientious providers could be unaware of it, let alone know what to do about it.
As McKnight's Staff Writer Emily Mongan points out in “Depression treatments may increase risk of falls in SNF residents, study shows,” a psychosocial treatment for depression increased the likelihood of resident falls. I spoke with Suzanne Meeks, Ph.D., first author of the study, to discuss the problem and the results of her research.
Meeks and her colleagues studied the impact of the Behavioral Activities Intervention (BE-ACTIV) on depressed nursing home residents. They determined that the risk of falls in the treatment group was six times that of the control group, a statistically significant number.
Meeks told me all treatments for depression, including medication and behavioral interventions, increase the chance of falls. When an individual is no longer depressed, he or she has more energy to stand and walk, thus creating more opportunities to fall. If depression has immobilized them for some time, deconditioning may exacerbate the problem.
Meeks points out that more than 81% of her research subjects in both treatment and control groups were receiving antidepressants, suggesting that the behavioral intervention activated the residents more than the medication.
It's important to treat people for depression despite the increased risk for falls because, as Meeks states, “depression is a fall risk.” Other researchers have found that the risk of falls increases when an individual has more of the following risk factors: depressive symptoms, antidepressant use, high physiological fall risk, and poorer executive function. Any two of these risk factors increase the likelihood of a fall by 55%. Participants with three or four risk factors were 155% more likely to fall -- 155%!
The BE-ACTIV intervention
The BE-ACTIV model was quite successful in reducing depression, Meeks and her colleagues found, as described in an earlier article about their work. Study subjects in the 10-week treatment group were encouraged and assisted to participate in pleasant activities such as regularly scheduled group programs, in-room crafts and self-care such as haircuts. Compared to the “treatment as usual” control group, BE-ACTIV was “superior … in moving residents to full remission from depression.”
In addition, there was this particularly noteworthy point: “Staff did not report spending more time with the residents than they had before the intervention, but 86.4% reported improvement in their relationships with the residents.”
This is notable for a number of reasons: First, the intervention didn't require extra staff time, which is always at a premium. Second, having more pleasant relationships with residents improves workers' experiences on the job, which reduces turnover. And third, when residents have better interactions with staff members, they are less likely to be depressed. (I could probably dig up a study to support that claim, but that's been my observation over the years.)
Mitigating the risk of falls
If depression can contribute to falls and treating depression can also lead to falls, this creates a dilemma that can be addressed by using the following recommendations:
* Increase awareness of fall potential. Meeks and her coauthors encourage clinicians and researchers to be aware of the increased risk of falls as residents become less depressed and more active. Those in other LTC roles, such as nurses, aides and recreation therapists, can be directed to more closely monitor a resident whose depression is abating and to use the techniques listed below.
* Teach the residents about fall prevention. Many elders can benefit from knowing that they're at increased risk for falls as they become more active. They're likely to appreciate the opportunity to self-monitor and will be more motivated to participate in the subsequent suggestions.
* Refer for rehabilitation services. A resident who is starting to become more active after a period of inactivity may be helped by a stint in rehab to strengthen areas of physical weakness and reduce the likelihood of falling.
* Promote attendance in activities like tai chi. Recreation programs such as tai chi, exercise groups or balloon volleyball can simultaneously improve physical functioning while enhancing mood. Follow the lead of the BE-ACTIV program by including several of these pastimes on the recreation calendar each week and encouraging residents to attend.
Both falls and depression are significant health risks for elders in long-term care and, as the findings of the study show, they should be treated in conjunction with one another.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.