Depression in older people after fall-related injuries: a prospective study

Background: objectives of the study were i) to describe changes in depression in independently living people aged 57 or older with fall-related injuries, and ii) to examine the effect of incomplete recovery of physical functions on depression one year post-injury. Method: prospective cohort-study, including a pre-injury baseline and post-injury assessments at 8 weeks, 5 months and one year. The sample consisted of 159 patients who sustained various kinds of fall-related injuries to the limbs. Physical functioning was measured by the Groningen Activity Restriction Scale, depression by the Hospital Anxiety and Depression Scale. Additional variables in the study were age, gender, chronic medical conditions and severity of the injury (three level-groups). Pre- and post-injury levels of depression were compared by using Student's t-test and effect size indices. Hierarchical multivariate regression analysis was used to examine the contribution of change in physical functioning between baseline and one year post-injury to depression one year post-injury. Results: severity of the injury was not associated with depression. Mean depression levels of all patients remained stable until 5 months post-injury but increased between 5 months and one year. Physical functioning decreased between baseline and 8 weeks post-injury, increased between 8 weeks and 5 months but did not change after 5 months. One year post-injury, both disability and depression were higher than at baseline. Change in physical functioning between baseline and one year post-injury accounted for 19% of the variance in depression explained by the regression model. Conclusions: depressive reactions did not occur as long as patients experienced improvement in physical functioning but became manifest as recovery appeared to stagnate. No significant differences in this respect were found between hip fracture patients and patients with other injuries.