Depressive Symptoms, Chronic Pain, and Falls in Older Community-Dwelling Adults: The MOBILIZE Boston Study

OBJECTIVES: To examine whether overall depressive symptoms and symptom clusters are associated with fall risk and to determine whether chronic pain mediates the relationship between depression and fall risk in aging. DESIGN: Prospective cohort study. SETTING: Boston, Massachusetts, and surrounding communities. PARTICIPANTS: Older community-dwelling adults (N = 722, mean age 78.3). MEASUREMENTS: Depressive symptomatology was assessed at baseline using the 20-item Hopkins Revision of the Center for Epidemiologic Studies Depression Scale (CESDR) as overall depression and two separate domains: cognitive and somatic symptoms. Chronic pain was examined at baseline as number of pain sites (none, single site, or multisite), pain severity, and pain interference with activities of daily living. Participants recorded falls on monthly postcards during a subsequent 18-month period. RESULTS: According to negative binomial regression, the rate of incident falls was highest in those with the highest burden of depressive symptoms (according to total CESDR and the cognitive and somatic CESDR domains). After adjustment for multiple confounders and fall risk factors, fall rate ratios comparing the highest three CESDR quartiles with the lowest quartile were 1.91, 1.26, and 1.11, respectively. Similarly graded associations were observed according to the CESDR domains. Although pain location and interference were mediators of the relationship between depression and falls, adjustment for pain reduced fall risk estimates only modestly. There was no interaction between depression and pain in relation to fall risk. CONCLUSION: Depressive symptoms are associated with fall risk in older adults and are mediated in part by chronic pain. Research is needed to determine effective strategies for reducing fall risk and related injuries in older people with pain and depressive symptoms. J Am Geriatr Soc 60: 230-237, 2012.